Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter?

Chisholm, Latarsha; Weech‐Maldonado, Robert; Laberge, Alex; Lin, Feng; Hyer, Kathryn

doi:10.1111/1475-6773.12079

Cited by 45 publications

(60 citation statements)

References 35 publications

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“…Many facilities in the high concentration group rely heavily on payments from Medicaid (which uses a much lower daily rate than private payers do) and are financially strained. [10] Thus, it is possible that the recent recession may have negatively affected the financial performance of nursing homes with high concentrations of racial/ethnic minority residents in particular, leading to CNA staffing reductions in those facilities.…”

Section: Discussionmentioning

confidence: 99%

“…For each year from 2000 to 2010 we obtained the following facility-level covariates from OSCAR, which had potential associations with nursing home operations and staffing inputs:[10,12,14,16,20] number of beds, affiliation with a chain (yes or no), ownership type (for-profit, nonprofit, or government owned), occupancy rate, percentage of Medicare residents, percentage of Medicaid residents, and location in a rural county (yes or no). We obtained data on the following additional covariates from the LTCfocus facility files, the percentage of female residents, average age of residents, and a facility-level case-mix index that was derived from the Resource Utilization Group (RUG) III classification[28] of all residents in the facility on the first Thursday of April in each year.…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…[1–4] A large body of literature has also reported that widespread disparities exist across facilities essentially because racial/ethnic minority residents tend to be cared for in facilities with limited financial and clinical resources and high numbers of care deficiencies. [5–10] In a landmark study conducted more than a decade ago, Vincent Mor and coauthors[5] reported that across the United States 40 percent of black residents, but only 9 percent of whites, resided in these lower-tier facilities.…”

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confidence: 99%

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Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001–11

Harrington

Mukamel

et al. 2015

Health Affairs

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Recent increases in state Medicaid payments to nursing homes have the potential to reduce disparities in nurse staffing between facilities with high and low concentrations of racial/ethnic minority residents. Analyses of nursing home and state policy survey data for the period 2001–11 suggest that registered nurse and licensed practical nurse staffing levels increased slightly during this period, regardless of racial/ethnic minority resident concentration. Adjusted disparities in registered nurse hours per resident day between nursing homes with high and low concentrations of racial/ethnic minority residents persisted, although they were reduced. Certified nursing assistant hours per patient day increased in nursing homes with low concentrations of racial/ethnic minorities but decreased in homes with high concentrations, creating a new disparity. Overall, increases in state Medicaid payment rates to nursing homes were associated with improvements in staffing and reduced staffing disparities across facilities, but the adoption of case-mix payments had the opposite effect. Further reforms in health care delivery and payment are needed to address persistent disparities in care between nursing homes serving higher proportions of minority residents and those serving lower proportions, and to prevent unintended exacerbations of such disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Study Data and Methodsmentioning

confidence: 99%

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confidence: 99%

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Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001–11

Harrington

Mukamel

et al. 2015

Health Affairs

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“…Nursing homes with higher proportions of black residents and rural nursing homes also exhibited worse processes and outcomes [45][46][47]. …”

Section: Evidence Of Low Quality In Nursing Homes and Changes In Qualmentioning

confidence: 99%

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Xing¹,

Mukamel²,

Glance³

et al. 2016

WHM

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2013ii Biographical SketchThe author was born in Shanghai, China. She attended Shanghai Second Medical This dissertation provides evidence that linking Medicaid reimbursement rate to each NH's own expenditures and incentivizing NHs to invest in direct care were effective ways in achieving quality improvement. Refinements of current Medi-Cal reimbursement policy might be needed to encourage NHs to make larger investments. However, maximizing NHs' spending on direct care cannot be relied on as the only policy strategy to improve quality of care. vii Contributors and Funding SourcesThis work was supervised by a dissertation committee consisting of Professors

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“…First, disparities are widespread, spanning diverse diagnoses and conditions such as chronic pain, 5 influenza and pneumococcus vaccinations, 6,7 and pressure ulcers. 8,9 Second, nursing home care tends to be highly segregated with racial/ethnic minority residents disproportionately concentrated in facilities with more limited clinical and financial resources; 4,8–11 thus, widespread disparities are largely an issue of the type of facilities serving the residents (i.e. a site-of-care issue).…”

Section: Introductionmentioning

confidence: 99%

Trends in Family Ratings of Experience With Care and Racial Disparities Among Maryland Nursing Homes

Li¹,

Ye²,

Glance

et al. 2014

Medical Care

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Background Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities. Methods We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007–2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food & meals; physical environment; and autonomy & personal rights. Results Overall ratings on care experience remained relatively high (mean=8.3 on a one-to-ten scale) during 2007–2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (p<0.01) except for food & meals (p=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (p<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (p>0.2 for trends in disparities). Conclusions Although Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.

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Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter?

Cited by 45 publications

References 35 publications

Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001–11

Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001–11

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Trends in Family Ratings of Experience With Care and Racial Disparities Among Maryland Nursing Homes

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