Nursing Home Profit Margins and Citations for Infection Prevention and Control

Sharma, Hari; Xu, Lili

doi:10.1016/j.jamda.2021.03.024

Cited by 12 publications

(41 citation statements)

References 21 publications

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“…Similarly, a study has noted that training is important to avoid medication errors in assisted living facilities 10 . In the nursing home industry, we have evidence that low staffing levels, lack of training and education, and lower profit margins are associated with deficiency citations 11–13 …”

Section: Introductionmentioning

confidence: 82%

Prevalence and persistency of deficiency citations in Florida assisted living facilities

Sharma

2021

J American Geriatrics Society

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Background: Assisted living facilities (ALFs) are plagued with quality issues but there are limited studies on the quality of ALFs. In Florida, state surveyors conduct inspections of ALFs and cite and/or fine facilities that are in violation of regulations. Yet, we do not know the types of quality problems identified and the extent to which facilities repeat such problems. In this study, we begin to fill this gap in our understanding of ALFs quality by summarizing the deficiency citations in Florida ALFs. Methods:We obtained inspection citation data on 957 large ALFs (bed size ≥ 25) in Florida from 2012 to 2018. Citation data are summarized at the facility-year level and classified into different groups such as resident care, admissions, medication, staffing, and training. We examined the trends in citations over time and stratified citations by profit status, license type, and facility size. We also assessed repeat citations among the ALFs.Results: Of the 957 large ALFs operating in Florida, 87% of the facilities were cited one or more times from 2012 to 2018. In 2018, the most common citations were related to medications (26.2%), resident care (25.3%), training (25.3%), admissions (21.1%), and staffing (20.8%). For-profit facilities, facilities with beds over 100, and facilities with limited mental health license tended to be cited more often across most types of deficiencies. Repeat citations are common with over 40% of facilities cited in two or more years for resident care and medication from 2012 to 2018.Conclusions: Our findings suggest that repeat citations are common and ALFs do not improve quality on a long-term basis after citations. If we want to improve ALFs quality, we may need to provide appropriate incentives and resources to ALFs along with stringent enforcement of regulations.

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Section: Introductionmentioning

confidence: 82%

Prevalence and persistency of deficiency citations in Florida assisted living facilities

Sharma

2021

J American Geriatrics Society

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“…(87) Likewise, total nurse staffing levels (all grades of nurse staff) and compliance were positively associated in eleven studies (36,45,51,54,87,110,111,128,153,156,158) , with two finding a negative association (49,111) and three a null association. (37,72,84) The results are similar for nurse aides/care assistants: 15 studies reported higher levels these staff and compliance were positively associated (15,35,37,48,49,51,54,56,58,79,90,126,128,138,154,156) , nine reported a null association (16,52,61,88,89,110,113,120,155) and three reported a negative association. (45,47,57) A higher ratio of registered nurses as against other nurse and care staff and compliance was positively associated in four studies (92,…”

Section: Other: Staffingmentioning

confidence: 74%

“…(36,45,48,159) Higher levels of licensed practitioner/vocational nurses and compliance were positively associated in five (54,56,57,70,154) , negative in five (45,47,48,51,106) , and a null association reported in 13. (15,49,52,58,61,79,88,89,110,113,120,138,156) Higher specialist staff levels (e.g. dietary professionals) and compliance were positively associated in five studies (15,35,81,154,160) , negative in one (118) ; and null in two.…”

Section: Other: Staffingmentioning

confidence: 96%

“…a chain of hospitals owned by one corporation). Of 20 studies investigating competition, four reported high competition was positively associated with compliance (45)(46)(47)(48) , four had a negative association (49)(50)(51)(52) , 11 reported a null association (13,(53)(54)(55)(56)(57)(58)(59)(60)(61)(62) ; one had a u-shaped finding where higher competition and monopoly were both positively associated whereas moderate competition was negatively associated. (63) Other studies investigated NH markets in a region.…”

Section: Mimetic or Competitive Pressure To Implement An Innovation T...mentioning

confidence: 99%

“…For-profit service providers and compliance were negatively associated in 29 studies (13, 30, 40, 45, 46, 49-51, 55, 59, 64, 72, 74, 77, 79, 81, 83, 85, 93, 95, 99, 103-105, 109, 117-120) , positively associated in seven (47,52,57,90,110,115,121) , with a null association in 17 studies. (36,37,48,54,56,58,61,66,71,80,86,88,89,111,(122)(123)(124) Aligned to the profit motive, in a qualitative study, staff in poorly-performing NHs (as measured by compliance) were instructed to prioritise the admission of people that attracted higher fees. (125) Larger facilities and compliance were negatively associated in 40 studies (13, 15, 35-38, 45-47, 49-51, 53, 57-59, 61, 66, 74, 79, 81, 82, 85, 86, 89, 90, 93, 95, 96, 106, 109, 111, 113, 115, 116, 118, 123, 124, 126, 127) ; three reported a positive association (48,52,71) and 16 a null association.…”

Section: Structural Characteristicsmentioning

confidence: 99%

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Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

Dunbar

Keyes

Browne

2022

Preprint

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Background The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of minimum standards by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. Methods Systematic searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two independent reviewers. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. Results The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. We found the following structural characteristics and compliance to be positively associated: smaller facilities (as measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility’s geographic location and compliance was also associated. We make no findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. Conclusion The literature in this field has focused to date on the structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work focused on the mechanisms involved in implementing regulations, are evident in the literature and further research in this area is needed to provide a clearer picture.

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Development and verification of a prediction model for outcomes of elderly patients with nursing home-acquired pneumonia

Zhou,

Tan,

Huo

et al. 2024

Applied Nursing Research

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Nursing Home Profit Margins and Citations for Infection Prevention and Control

Cited by 12 publications

References 21 publications

Prevalence and persistency of deficiency citations in Florida assisted living facilities

Prevalence and persistency of deficiency citations in Florida assisted living facilities

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

Development and verification of a prediction model for outcomes of elderly patients with nursing home-acquired pneumonia

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