scholarly journals Empty Beds in Nursing Homes Filled by Younger Individuals Following ACA Medicaid Eligibility Expansion

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Ashley Ritter ◽  
Norma Coe ◽  
Salama Freed
Keyword(s):  
Nursing Homes ◽  
Patient Outcomes ◽  
Low Income ◽  
Fixed Effects ◽  
Severity Index ◽  
Occupancy Rate ◽  
Percentage Point Increase ◽  
Medicaid Eligibility ◽  
Facility Level ◽  
Occupancy Rates

Abstract National decline in nursing home occupancy rates coupled with expansion of Medicaid insurance eligibility under the Affordable Care Act (ACA) potentially create an opportunity for younger, low-income individuals to enter nursing homes following a hospitalization. Changes in the population of individuals using nursing homes could result in downstream consequences on facility payor mix, case severity index, and ultimately patient outcomes. This study measures the effect of ACA Medicaid eligibility expansion on the patient population using nursing homes, accounting for the nursing homes’ occupancy rate. Data were obtained from the publicly available national dataset, LTCfocus (2009-2016). Difference in differences estimation with time and state fixed effects was utilized to examine the effect of ACA Medicaid eligibility expansion on two outcomes, 1) average age in years of residents as of April 1 and 2) the proportion of individuals covered by Medicaid insurance at the facility level. Results show facilities with pre-ACA occupancy rates between 40% and 50% demonstrated the largest decrease in average age by year three, 1.32 years [95% CI: -2.257, -0.385]. Facilities with a pre-ACA occupancy rate of 60-70% demonstrated the largest increase in the proportion of individuals covered by Medicaid in year one, a 5.5 percentage point increase [95% CI: 0.009, 0.102]. In summary, Medicaid expansion under the ACA resulted in an increase in younger individuals and individuals covered by Medicaid using nursing homes, varying across pre-ACA occupancy rates. It remains to be studied if increased utilization of this high cost setting provides superior patient outcomes for these populations.

Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care–Associated Infections in the NICU

2017 ◽  
Vol 34 (10) ◽  
pp. 0996-1002 ◽  
Author(s):  
Régis Blais ◽  
Guy Lacroix ◽  
Michèle Cabot ◽  
Bruno Piedboeuf ◽  
Marc Beltempo
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Nurse Staffing ◽  
Occupancy Rate ◽  
Staffing Ratio ◽  
Health Care Associated Infections ◽  
Occupancy Rates

Objective This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care–associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database “Logibec” and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05–2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47–1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67–1.99, Q4 vs. Q1). Conclusion Nursing overtime is associated with higher odds of HCAI in the NICU.

scholarly journals High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance

2019 ◽  
Vol 56 ◽  
pp. 004695801882506
Author(s):  
Robert Weech-Maldonado ◽  
Justin Lord ◽  
Rohit Pradhan ◽  
Ganisher Davlyatov ◽  
Neeraj Dayama ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Financial Performance ◽  
Nurse Practitioners ◽  
Fixed Effects ◽  
Market Competition ◽  
Physician Assistants ◽  
Occupancy Rate ◽  
Term Care ◽  
For Profit ◽  
Market Factors

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.

scholarly journals The Non-Linear Relationship Between Fiscal Deficits And Inflation: Evidence From Africa

2015 ◽  
Vol 10 (2) ◽  
pp. 102-112
Author(s):  
Nurudeen Abu ◽  
Mohd Zaini Abd Karim
Keyword(s):  
Linear Relationship ◽  
Low Income ◽  
Fixed Effects ◽  
Low Income Countries ◽  
African Countries ◽  
Middle Income ◽  
Percentage Point Increase ◽  
Point Increase ◽  
Non Linear ◽  
High Inflation

AbstractAlthough, there is abundant research on the fiscal deficit-inflation relationship, little has been done to investigate the non-linear association between them, particularly in Africa. This study employs fixed-effects and GMM estimators to examine the non-linear relationship between deficits and inflation from 1999 to 2011 in 51 African economies, which are further grouped into high-inflation/low-income countries and moderate-inflation/middle-income countries. The results indicate that the deficit-inflation relationship is non-linear for the whole sample and sub-groups. For the whole sample, a percentage point increase in deficit results in a 0.25 percentage point increase in inflation rate, while the relationship becomes quantitatively greater once deficits reach 23% of GDP. The subsamples report different relationships. Although our results cannot be used as the base for generalization, we identify importance of grouping African countries according to their levels of inflation and/or income, rather than treating them as a homogeneous entity.

Association of State-Level Earned Income Tax Credits With Rates of Reported Child Maltreatment, 2004–2017

2021 ◽  
pp. 107755952098730
Author(s):  
Nicole L. Kovski ◽  
Heather D. Hill ◽  
Stephen J. Mooney ◽  
Frederick P. Rivara ◽  
Erin R. Morgan ◽  
...  
Keyword(s):  
Child Maltreatment ◽  
Low Income ◽  
Emotional Abuse ◽  
Income Tax ◽  
Fixed Effects ◽  
Statistical Significance ◽  
State Level ◽  
Economic Security ◽  
Earned Income ◽  
Percentage Point Increase

Poverty is an important predictor of child maltreatment. Social policies that strengthen the economic security of low-income families, such as the Earned Income Tax Credit (EITC), may reduce child maltreatment by impeding the pathways through which poverty leads to it. We used variations in the presence and generosity of supplementary EITCs offered at the state level and administrative child maltreatment data from the National Child Abuse and Neglect Data System (NCANDS) to examine the effect of EITC policies on state-level rates of child maltreatment from 2004 through 2017. Two-way fixed effects models indicated that a 10-percentage point increase in the generosity of refundable state EITC benefits was associated with 241 fewer reports of neglect per 100,000 children (95% Confidence Interval [CI] [−449, −33]). An increase in EITC generosity was associated with fewer reports of neglect both among children ages 0–5 (−324 per 100,000; 95% CI [−582, −65]) and children ages 6–17 (−201 per 100,000; 95% CI [−387, −15]). Findings also suggested associations between the EITC and reductions in other types of maltreatment (physical abuse, emotional abuse); however, those did not gain statistical significance. Economic support policies may reduce the risk of child maltreatment, especially neglect, and improve child wellbeing.

scholarly journals The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Layana Costa Alves ◽  
Mauro Niskier Sanchez ◽  
Thomas Hone ◽  
Luiz Felipe Pinto ◽  
Joilda Silva Nery ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Negative Binomial ◽  
Malaria Incidence ◽  
Panel Study ◽  
Negative Binomial Regression ◽  
Brazilian Amazon ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Percentage Point Increase ◽  
The Impact

Abstract Background Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. Methods A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. Results A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994–0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004–2015 corresponding to be a reduction of 7.2% in the malaria incidence. Conclusions Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.

scholarly journals Culture Change Initiatives in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Fixed Effects ◽  
Ethnic Disparities ◽  
State Level ◽  
Change Initiatives ◽  
Term Care ◽  
Star Rating ◽  
Racial Ethnic

Abstract Racial/ethnic disparities have been well documented in long-term care literature. As the population ages and becomes more diverse over time, it is essential to identify mechanisms that may eliminate or mitigate racial/ethnic disparities. Culture change is a movement to transition nursing homes to more home-like environments. The literature on culture change initiatives and quality has been mixed, with little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

scholarly journals KAJIAN FAKTOR-FAKTOR YANG MEMPENGARUHI PENYERAPAN TENAGA KERJA DAN KESEJAHTERAAN MASYARAKAT DI PROVINSI BALI

2021 ◽  
pp. 1115
Author(s):  
Ketut Candri ◽  
I Komang Gde Bendesa
Keyword(s):  
Path Analysis ◽  
Dominant Role ◽  
Secondary Data ◽  
Occupancy Rate ◽  
Total Employment ◽  
Insignificant Effect ◽  
The People ◽  
Analysis Technique ◽  
Occupancy Rates ◽  
Central Statistics

  Bali is an island where tourism plays a dominant role in its economy, so its potential needs to be further developed. The purpose of this study is to analyze the effect of tourist visits, number of hotels, and hotel occupancy rates on total employment and welfare of the people in Bali. The data used is secondary data published by Bali Provincial Tourism Office and the Bali Province Central Statistics Agency from 2000-2019. The analysis technique used is path analysis. The results showed that the number of tourist visits has a positive and significant effect on total employment, the number of hotels has a negative and insignificant effect on total employment, while the hotel occupancy rate has a positive and insignificant effect on total employment. In addition, the number of tourist visits has a negative and insignificant effect on welfare, the number of hotels and the total employment have a positive and significant effect on welfare, while the hotel occupancy rate has a negative and significant effect on the welfare of the community.  Labor absorption is not a mediating variable between tourist visits and occupancy rate on welfare.

scholarly journals Peramalan Tingkat Penghunian Tempat Tidur Hotel Bintang Tiga Kota Surakarta Menggunakan Metode Autoregressive Integrated Moving Average (ARIMA)

2019 ◽  
Vol 2 (1) ◽  
pp. 53
Author(s):  
Shindy Dwi Pratiwi
Keyword(s):  
Moving Average ◽  
Hotel Industry ◽  
Occupancy Rate ◽  
Autoregressive Integrated Moving Average ◽  
Occupancy Rates ◽  
The City

<p>Surakarta is a cultural city that is now starting to attract domestic and foreign tourists. This makes many tourists visit the city of Surakarta so that it affects the occupancy rate of hotels in Surakarta. The occupancy rate of hotels in Surakarta has fluctuations from each year. The uncertainty of hotel occupancy rates in Surakarta will certainly affect investors to choose policies in the hotel industry so that hotel occupancy rates in Surakarta City need to be estimated for the next year. In this study, the Autoregressive Integrated Moving Average (ARIMA) method was used to forecast hotel occupancy rates in Surakarta from January to May 2018. By using the best model IMA (1.1), it was concluded that the occupancy rate of three-star Surakarta hotels increased every the month.</p><p><strong>Keywords</strong><strong> : </strong>occupancy rate of hotel, forecasting, ARIMA.</p>

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