Nursing home performance in resident care in the United States: is it only a matter of for-profit versus not-for-profit?

2008 ◽  
Vol 3 (2) ◽  
pp. 115-140 ◽  
Author(s):  
FREDERIC H. DECKER
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Resource Dependence ◽  
Physical Restraint ◽  
Resource Dependence Theory ◽  
The United States ◽  
For Profit ◽  
Not For Profit ◽  
Resident Care ◽  
Restraint Use

Abstract:Poorer resident care in US for-profit relative to not-for-profit nursing homes is usually blamed on the profit motive. But US nursing home performance may relate to Medicaid public financing in a manner qualifying the relationship between ownership and quality. We investigated effects of Medicaid resident census, Medicaid payment, and occupancy on performance. Resource dependence theory implies these predictors may affect discretion in resources invested in resident care across for-profit and not-for-profit facilities. Models on physical restraint use and registered nurse (RN) staffing were studied using generalized estimating equations with panel data derived from certification inspections of nursing homes. Restraint use increased and RN staffing levels decreased among for-profit and not-for-profit facilities when the Medicaid census increased and Medicaid payment decreased. Interaction effects supported a theory that performance relates to available discretion in resource allocation. Effects of occupancy appear contingent on the dependence on Medicaid. Poorer performance among US for-profit nursing homes may relate to for-profit homes having lower occupancy, higher Medicaid census, and operating in US states with lower Medicaid payments compared to not-for-profit homes. Understanding the complexity of factors affecting resources expended on resident care may further our understanding of the production of quality in nursing homes, whether in the US or elsewhere.

scholarly journals Informing Policy from Prices: An Overview of California Nursing Homes

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Karen El Hajj
Keyword(s):  
Regression Analysis ◽  
Nursing Home ◽  
Nursing Homes ◽  
The United States ◽  
The State ◽  
Health Policies ◽  
For Profit ◽  
Home Prices ◽  
The Us ◽  
Occupancy Rates

Introduction: The rising cost of healthcare along with the aging demographic requires the attention of policy makers. The United States’ nursing home industry is costly to older adults, requiring many to resort to government funded Medicare to offset these costs. This study aims to understand determinants of nursing home prices in the state of California. Variables included in the analysis are selected based on previous literature on the costs of nursing homes in the US. Methods: The data were analyzed using a multi-variable regression analysis. The analysis sample included 1,121 nursing homes across California, using facility level and governmental data that is publically available for the years of 2016-2017. Data collected included financial indicators (net income), ownership (for-profit, non-profit) represented as a dummy variable, occupancy rates, reimbursement rates (Medicare & Medicaid), staffing, quality and competition variables such as nursing homes per county. Results: The regression analysis indicated that ownership type (for-profit), competition and occupancy rates have a negative significant effect on nursing home prices. Whereas, reimbursement rates of both Medicare and Medicaid, home income and staffing levels have a positive significant effect, driving further nursing home prices. Conclusion: The study aimed to understand the relevant variables that influence nursing home prices in the state of Califronia. The regression analysis yielded significant results for various factors including reimbursement rates, occupancy rates and the number of nursing homes per county. However, a notable limitation to the study is the inability to generalize these factors to the rest of the US due to state specific health policies. Determinants such as reimbursement rates and nursing homes per county vary by governmental decisions, therefore, a comprehensive policy tool could be designed to alter nursing home costs through state health policies.

scholarly journals Organizational and Geographic Nursing Home Characteristics Associated With Increasing Prevalence of Resident Obesity in the United States

2019 ◽  
Vol 39 (9) ◽  
pp. 991-999
Author(s):  
John Alexander Harris ◽  
John Engberg ◽  
Nicholas George Castle
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Prevalence Rate ◽  
Profit Maximization ◽  
The United States ◽  
Study Cohort ◽  
Obesity Prevalence ◽  
For Profit ◽  
Profit Status ◽  
Bed Capacity

Nursing home resident obesity increases the complexity of nursing care, and nursing homes report avoiding residents with obesity when choosing which prospective residents to accept. The objective of this study was to examine the associations between nursing home obesity prevalence rate and nursing home organizational, staffing, resident, and geographic factors within a profit maximization framework. The study cohort included U.S. Centers for Medicare and Medicaid Services data from U.S. nursing homes in 2013. Study findings supported hypothesized associations between obesity prevalence rate and higher occupancy, higher bed capacity, and multi-facility affiliation, but findings did not support a relationship between obesity prevalence rate and for-profit status.

scholarly journals Exploring the N95 and Surgical Mask Supply in U.S. Nursing Homes During COVID-19

2020 ◽  
pp. 073346482096901
Author(s):  
Yumeng Li ◽  
Fang Fang ◽  
Mengying He
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Health Care Facilities ◽  
Protective Equipment ◽  
County Level ◽  
Multivariate Logistic Regression ◽  
For Profit ◽  
Not For Profit ◽  
Surgical Masks ◽  
Care Facilities

U.S. health care facilities have been encountering a recurrence of medical supply shortage since COVID-19 exploded in March 2020. There is an urgent need for important Personal Protective Equipment (PPE) such as N95 and surgical masks. This project examined the factors that were associated with nursing homes’ N95 and surgical mask supply. We analyzed data from the Nursing Home COVID-19 Public File and conducted a multivariate logistic regression estimating the association between nursing home characteristics and county-level demographic parameters with mask supply. We found that a high number of resident COVID-19 cases contributed to the supply of N95, but not surgical masks, whereas a high number of staff cases did not lead to an adequate supply of either N95 or surgical masks. Compared with not-for-profit (NFP) facilities, for-profit (FP) nursing homes were less likely to get enough masks. A better supply distribution plan is needed to prepare for future possible PPE shortage.

scholarly journals Patterns of B Corps Certification: The Role of Institutional, Economic, and Political Resources

Societies ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 72
Author(s):  
Caddie Putnam Rankin ◽  
Todd Lee Matthews
Keyword(s):  
Resource Dependence ◽  
External Environment ◽  
State Level ◽  
Resource Dependence Theory ◽  
The United States ◽  
For Profit ◽  
Institutional Economic ◽  
Political Resources ◽  
Dependence Theory

This paper explores the certification of companies as B Corps from 2007 through 2016, the first 10 years of certification. B Corps are for profit companies that promise to “Be a Force for Good” in our society. Over 2600 companies in over 50 countries are certified as B Corps, responding to demands for higher accountability, ethical behavior, and contributions to their environment and community. We focus here only on B Corps in the United States and analyze a state-level database we have developed of 851 companies that became certified in the first 10 years of certification, between 2007 and 2016. In the paper we ask: What conditions in the macro environment facilitate the spread of B Corps certification? This paper uses the framework of resource dependence theory and institutional theory to explore the diffusion of certification. We hypothesize that institutional, economic, and political resources in the external environment provide conditions that support B Corps certification.

Multitasking in Nursing Homes: Differences Between For-Profit and Nonprofit Quality Outcomes

2018 ◽  
Vol 59 (6) ◽  
pp. 1034-1043
Author(s):  
Jennifer Gaudet Hefele ◽  
Xiao (Joyce) Wang ◽  
Christine E Bishop ◽  
Adrita Barooah
Keyword(s):  
Nursing Homes ◽  
Quality Measures ◽  
The United States ◽  
Quality Outcomes ◽  
For Profit ◽  
Not For Profit ◽  
Resource File ◽  
Improved Performance ◽  
Design And Methods

Abstract Background and Objectives Nursing homes (NHs) in the United States face increasing pressures to admit Medicare postacute patients, given higher payments relative to Medicaid. Changes in the proportion of residents who are postacute may initiate shifts in care practices, resource allocations, and priorities. Our study sought to determine whether increases in Medicare short-stay census have an impact on quality of care for long-stay residents. Research Design and Methods This study used panel data (2005–2010) from publicly-available sources (Nursing Home Compare, Area Health Resource File, LTCFocus.org) to examine the relationship between a 1-year change in NH Medicare census and 14 measures of long-stay quality among NHs that experienced a meaningful increase in Medicare census during the study period (N = 7,932). We conducted analyses on the overall sample and stratified by for- and nonprofit ownership. Results Of the 14 long-stay quality measures examined, only one was shown to have a significant association with Medicare census: increased Medicare census was associated with improved performance on the proportion of residents with pressure ulcers. Stratified analyses showed increased Medicare census was associated with a significant decline in performance on 3 of 14 long-stay quality measures among nonprofit, but not for-profit, facilities. Discussion and Implications Our findings suggest that most NHs that experience an increase in Medicare census maintain long-stay quality. However, this may be more difficult to do for some, particularly nonprofits. As pressure to focus on postacute care mount in the current payment innovation environment, our findings suggest that most NHs will be able to maintain stable quality.

A Resource Dependence Perspective on Low-Power Actors Shaping Their Regulatory Environment: The Case of Honda

2016 ◽  
Vol 38 (8) ◽  
pp. 1039-1058 ◽  
Author(s):  
Ei Shu ◽  
Arie Y. Lewin
Keyword(s):  
Low Power ◽  
Automobile Industry ◽  
Environmental Protection Agency ◽  
Resource Dependence ◽  
Resource Dependence Theory ◽  
The United States ◽  
Regulatory Environment ◽  
For Profit ◽  
Focal Firm ◽  
Empirical Context

The central focus of this paper is a largely unexplored research domain relating to how low-power for-profit actors can shape their political and regulatory environment and create economic opportunities that affect their survival and growth. The paper builds on and extends the concept of “negotiating the environment” and on how organizations create their environment, with an emphasis on low-power actors. Resource dependence theory (RDT) has been very influential in exploring the many ways in which firms can decrease or overcome resource vulnerabilities in their environment with a focus on high-power actors (large companies, resource-rich companies, industrial associations, and political power of highly endowed companies). However, whether and how low-power actors can shape their political, regulatory, and economic environment was not central to RDT analysis, which is the focus of this paper. The empirical context for this research is the emergence and enactment of automobile emissions standards in Japan following the adoption in the United States of the Clean Air Act in December 1970. The focal firm is the Honda Motor Company, which, at that time, was a negligible competitor in the Japanese automobile industry and had no legitimate political or institutional standing. Yet the company was successful in undoing the cartel-like dominance of the two largest Japanese automobile manufacturers and the Japanese Environmental Protection Agency. The focus of this paper is describing the phenomenon and developing new theoretical insights relating to how low-power for-profit actors are able to negotiate their environment.

scholarly journals A Stage Set for Disaster: For-Profit Nursing Homes, Federal Law, and COVID-19

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
David Papke
Keyword(s):  
United States ◽  
Twentieth Century ◽  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
The United States ◽  
Nursing Home Care ◽  
Federal Law ◽  
For Profit

This article exposes the tragic relationship between for-profit nursing homes and the spread of COVID-19 in those facilities. For-profit nursing homes came to dominate nursing-home care in the United States in the second half of the twentieth century. However, for-profit nursing homes on average provided care which was inferior to the care provided in state-run and nonprofit nursing homes. Congress attempted to address the problems in nursing homes in the final decades of the twentieth century, but massive statutes and abundant regulations served mostly to legitimize for-profit nursing homes. COVID-19 then underscored the flaws in the legally sanctioned, for-profit nursing homes, as thousands died within the problematic institution’s walls.

Nursing professionals’ attitudes toward use of physical restraints in Styrian nursing homes Austria

Pflege ◽  
2019 ◽  
Vol 32 (1) ◽  
pp. 57-63
Author(s):  
Hannes Mayerl ◽  
Tanja Trummer ◽  
Erwin Stolz ◽  
Éva Rásky ◽  
Wolfgang Freidl
Keyword(s):  
Nursing Homes ◽  
Large Scale ◽  
Critical Role ◽  
Physical Restraint ◽  
Care Practice ◽  
Physical Restraints ◽  
Convenience Sample ◽  
Restraint Use ◽  
Positive Attitudes ◽  
Nursing Professionals

Abstract. Background: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals’ attitudes toward this practice. Aim: Since nursing professionals’ views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals’ attitudes concerning use of physical restraints in nursing homes of Styria (Austria). Method: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. Results: The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny “good reasons” for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals’ views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. Conclusions: Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.

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