Is the Quality of Nursing Homes Countercyclical? Evidence From 2001 Through 2015

2018 ◽  
Vol 59 (6) ◽  
pp. 1044-1054 ◽  
Author(s):  
Sean Shenghsiu Huang ◽  
John R Bowblis
Keyword(s):  
Nursing Homes ◽  
Unemployment Rate ◽  
Nursing Staff ◽  
Employee Turnover ◽  
Local Economy ◽  
Care Process ◽  
Process Measures ◽  
Unemployment Rates ◽  
For Profit ◽  
Design And Methods

Abstract Background and Objectives To examine whether nursing homes (NHs) provide better quality when unemployment rates rise (countercyclical) and explore mechanisms contributing to the relationship between quality and unemployment rates. Research Design and Methods The study uses the data on privately owned, freestanding NHs in the continental United States that span a period from 2001 through 2015. The empirical analysis relies on panel fixed-effect regressions with the key independent variable being the county-level unemployment rate. NH quality is measured using deficiencies, outcomes, and care process measures. We also examine nursing staff levels, as well as employee turnover and retention. Results NHs have better quality when unemployment rates increase. Higher unemployment rates are associated with fewer deficiencies and lower deficiency scores. This countercyclical relationship is also found among other quality measures. In terms of mechanisms, we find higher nursing staff levels, lower employee turnover, and better workforce retention when unemployment rates rise. Improvement in staffing is likely contributing to better quality during recessions. Interestingly, these effects predominately occur in for-profit NHs for deficiencies and staffing levels. Discussions and Implications NH quality is countercyclical. With near record-low unemployment rates in 2018, regulatory agencies should pay close attention to NH quality when and where the local economy registers strong growth. On the other hand, the finding of the unemployment rate–staffing/turnover relationship also suggests that policies increasing staffing and reducing employee turnover may not only improve NH quality but also have the potential to smooth quality fluctuations between business cycles.

scholarly journals For-profit nursing homes and the risk of COVID-19 outbreaks and resident deaths in Ontario, Canada

2020 ◽  
Author(s):  
Nathan M. Stall ◽  
Aaron Jones ◽  
Kevin A. Brown ◽  
Paula A. Rochon ◽  
Andrew P. Costa
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Case Fatality ◽  
Design Standards ◽  
Term Care ◽  
Process Measures ◽  
Non Profit ◽  
Adjusted Risk ◽  
For Profit ◽  
Profit Status

AbstractBackgroundNursing homes have become the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada. Previous research demonstrates that for-profit nursing homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than non-profit homes.MethodsWe conducted a retrospective cohort study of all nursing homes in Ontario, Canada from March 29-May 20, 2020 using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between nursing home profit status (for-profit, non-profit or municipal) and nursing home COVID-19 outbreaks, COVID-19 outbreak sizes, and COVID-19 resident deaths.ResultsThe analysis included all 623 Ontario nursing homes, of which 360 (57.7%) were for-profit, 162 (26.0%) were non-profit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) COVID-19 nursing home outbreaks involving 5218 residents (mean of 27.5 ± 41.3 residents per home), resulting in 1452 deaths (mean of 7.6 ± 12.7 residents per home) with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak was associated with the incidence of COVID-19 in the health region surrounding a nursing home (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI] 1.23-3.09) and number of beds (aOR, 1.40; 95% CI 1.20-1.63), but not profit status. For-profit status was associated with both the size of a nursing home outbreak (adjusted risk ratio [aRR], 1.96; 95% CI 1.26-3.05) and the number of resident deaths (aRR, 1.78; 95% CI 1.03-3.07), compared to non-profit homes. These associations were mediated by a higher prevalence of older nursing home design standards in for-profit homes.Interpretation: For-profit status is associated with the size of a COVID-19 nursing home outbreak and the number of resident deaths, but not the likelihood of outbreaks. Differences between for profit and non-profit homes are largely explained by older design standards, which should be a focus of infection control efforts and future policy.

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.

scholarly journals Quality Concerns in Nursing Homes That Serve Large Proportions of Residents With Serious Mental Illness

2020 ◽  
Vol 60 (7) ◽  
pp. 1312-1321 ◽  
Author(s):  
Dylan J Jester ◽  
Kathryn Hyer ◽  
John R Bowblis
Keyword(s):  
Mental Illness ◽  
Nursing Homes ◽  
Serious Mental Illness ◽  
Linear Models ◽  
Logistic Models ◽  
Direct Care ◽  
For Profit ◽  
Staffing Levels ◽  
National Certification ◽  
Design And Methods

Abstract Background and Objectives Nursing homes (NHs) are serving greater proportions of residents with serious mental illness (SMI), and it is unclear whether this affects NH quality. We analyze the highest and lowest quartiles of NHs based on the proportion of residents with SMI and compare these NHs on facility characteristics, staffing, and quality stars. Research Design and Methods National Certification and Survey Provider Enhanced Reports data were merged with NH Compare data for all freestanding certified NHs in the continental United States in 2016 (N = 14,460). NHs were categorized into “low-SMI” and “high-SMI” facilities using the lowest and highest quartiles, respectively, of the proportion of residents in the NH with SMI. Bivariate analyses and logistic models were used to examine differences in organizational structure, payer mix, resident characteristics, and staffing levels associated with high-SMI NHs. Linear models examined differences in quality stars. Results High-SMI facilities were found to report lower direct-care staffing hours, have a greater Medicaid-paying resident census, were more likely to be for-profit, and scored lower on all NH Compare star ratings in comparison to all other NHs. Discussion and Implications As the SMI population in NHs continues to grow, a large number of residents have concentrated in a few NHs. These are uniquely different from typical NHs in terms of facility characteristics, staffing, and care practices. While further research is needed to understand the implications of these trends, public policymakers and NH providers need to be aware of this population’s unique—and potentially unmet—needs.

scholarly journals Profit Status and Employee Turnover in Iowa Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 570-571
Author(s):  
Hari Sharma ◽  
Lili Xu
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Employee Turnover ◽  
Older Individuals ◽  
High Turnover ◽  
Non Profit ◽  
For Profit ◽  
Percentage Points ◽  
Nursing Home Quality ◽  
Profit Status

Abstract Employee turnover is a huge concern for nursing homes that care for millions of older individuals whose physical and cognitive impairments make them vulnerable, especially in the middle of a pandemic like COVID-19. Existing research has shown that high turnover of employees can lead to poorer quality of care. Low pay is often cited as one of the key reasons for high turnover of employees in nursing homes. For-profit nursing homes may try to maximize profits by limiting wages paid to their employees. In this study, we examine whether profit-status of a facility is associated with high turnover of its employees. We obtain data on 415 nursing homes operating in Iowa between 2013-2017. We descriptively examine the turnover trends in nurse employees and all employees over time by profit status. We evaluate whether profit status is associated with high turnover using pooled linear regressions controlling for nursing home and resident characteristics. Descriptive results show that for-profit facilities had higher turnover of nurse employees (61.1% vs. 49.6%) and all employees (56.6% vs. 45.4%). Results from multivariate regressions show that, compared to non-profit facilities, for-profit facilities had 6.93 percentage points higher (p<0.01) turnover of all employees, and 7.76 percentage points higher (p<0.01) turnover of nurse employees after controlling for facility and resident characteristics. Given existing evidence on the adverse impact of high employee turnover on nursing home quality, we need policies aimed at lowering employee turnover, targeting for-profit nursing homes.

scholarly journals Does continuity in nursing staff matter? A pilot study on correlation of central line-associated bloodstream infections and employee turnover

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Thomas Scheier ◽  
Stefan P. Kuster ◽  
Mesida Dunic ◽  
Christian Falk ◽  
Hugo Sax ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Employee Turnover ◽  
Rank Correlation ◽  
Bloodstream Infections ◽  
Central Line ◽  
Incidence Rates ◽  
Nursing Personnel ◽  
Care Hospital ◽  
Spearman Rank Correlation ◽  
Spearman Rank

Abstract Background Understaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question. Methods In January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated. Results Over a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r =  −0.058, P = 0.787). Conclusions Prospectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates.

scholarly journals 2051. Frequency of Inappropriate Antibiotic Prescribing in Nursing Homes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S691-S691
Author(s):  
Chitra Kanchagar ◽  
Brie N Noble ◽  
Christopher Crnich ◽  
Jessina C McGregor ◽  
David T Bearden ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Tract Infection ◽  
Multidrug Resistant ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Term Care ◽  
Antibiotic Overuse ◽  
For Profit ◽  
Memory Care ◽  
Minimum Criteria

Abstract Background Antibiotics are among the most prescribed medications in nursing homes (NHs). The increasing incidence of multidrug-resistant and C. Difficile infections due to antibiotic overuse has driven the requirement for NHs to establish antibiotic stewardship programs (ASPs). However, estimates of the frequency of inappropriate antibiotic prescribing in NHs have varied considerably between studies. We evaluated the frequency of inappropriate antibiotic prescribing in a multi-state sample of NHs. Methods We utilized a retrospective, (20%) random sample of residents of 17 for-profit NHs in Oregon, California, and Nevada who received antibiotics between January 1, 2017 and May 31, 2018. Study NHs ranged in size from 50 to 188 beds and offered services including subacute care, long-term care, ventilator care, and Alzheimer’s/memory care. Data were collected from residents’ electronic medical records. Antibiotic appropriateness was defined using Loeb Minimum Criteria for initiation of antibiotics for residents with indications for lower respiratory tract infection (LRTI), urinary tract infection (UTI) and skin and soft-tissue infection (SSTI). Residents with other types of infections were excluded from the study. Results Among 232 antibiotic prescriptions reviewed, 61% (141/232) were initiated in the NH. Of these, 65% were for female residents and 81% were for residents above the age of 65. Nearly 70% (98/141) of antibiotic prescriptions were for an indication of an LRTI, UTI, or SSTI of which 51% (57% of LRTIs, 52% of UTIs, and 35% of SSTIs) did not meet the Loeb Minimum Criteria and were determined to be inappropriate. Among antibiotics that did not meet the Loeb Minimum Criteria, more than half were cephalosporins (40%) or fluoroquinolones (14%) and the median (interquartile range) duration of therapy was 7 (5–10) days. Conclusion These data from a multi-state sample of NHs suggest the continued need for improvement in antibiotic prescribing practices and the importance of ASPs in NHs. Disclosures All authors: No reported disclosures.

scholarly journals 2054. Hospital-initiated Antibiotics in Nursing Homes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S692-S692
Author(s):  
Jon P Furuno ◽  
Brie N Noble ◽  
Vicki Nordby ◽  
Bo Weber ◽  
Jessina C McGregor ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Hospital Setting ◽  
Antibiotic Prescribing ◽  
Administration Route ◽  
Electronic Health Record Data ◽  
For Profit ◽  
Duration Of Therapy ◽  
Record Data ◽  
One Year ◽  
The One

Abstract Background Nursing homes (NHs) are required by the Centers for Medicare and Medicaid Services to maintain antimicrobial stewardship programs. Hospital-initiated antibiotics may pose a barrier to optimizing antibiotic prescribing in this setting. Our objective was to characterize hospital-initiated antibiotic prescriptions among NH residents. Methods We collected electronic health record data on antibiotic prescribing events within 60 days of residents’ admission to 17 for-profit NHs in Oregon, California, and Nevada between January 1, and December 31, 2017. We characterized antibiotics prescribed, administration route, and proportion initiated in a hospital setting. Results Over the one-year study period, there were 4350 antibiotic prescribing events among 1633 NH residents. Mean (standard deviation) age was 77 (12) years and 58% were female. Approximately 45% (1,973/4,350) of antibiotics prescribed within 60 days of NH admission were hospital-initiated. The most frequently prescribed hospital-initiated antibiotics were cephalosporins (27%; 1st gen: 54%, 2nd gen: 6%, 3rd gen: 34%, 4th gen: 5%, 5th gen: 1%), fluoroquinolones (20%), and penicillins (14%; natural penicilins: 4%, semisynthetic penicillins: 3%, aminopenicillans: 57%, β-lactam/β-lactamase inhibitors: 21%, and antipseudomonal penicillins: 15%). Additionally, 24% of antibiotics were parenteral and the median (interquartile range) duration of therapy was 6 (3–10) days. Over 15% of residents with hospital-initiated antibiotics were readmitted to the hospital within 30 days. Conclusion Approximately 45% of antibiotic prescribing in a multistate sample of NHs were hospital-initiated, of which roughly 40% was broad-spectrum. Interventions specifically targeting antibiotic prescribing during and following the transition from hospitals to NHs are needed. Disclosures All authors: No reported disclosures.

scholarly journals The Use of Contract Licensed Nursing Staff in U.S. Nursing Homes

2006 ◽  
Vol 63 (1) ◽  
pp. 88-109 ◽  
Author(s):  
Meg Bourbonniere ◽  
Zhanlian Feng ◽  
Orna Intrator ◽  
Joseph Angelelli ◽  
Vincent Mor ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Nursing Staff

scholarly journals Unemployment and COVID-19 Impact in Greece: A Vector Autoregression (VAR) Data Analysis

2021 ◽  
Vol 5 (1) ◽  
pp. 41
Author(s):  
Christos Katris
Keyword(s):  
Data Analysis ◽  
Response Function ◽  
Unemployment Rate ◽  
Vector Autoregression ◽  
Impulse Response Function ◽  
Youth Unemployment ◽  
The Other ◽  
Var Model ◽  
Unemployment Rates ◽  
The Impact

In this paper, the scope is to study whether and how the COVID-19 situation affected the unemployment rate in Greece. To achieve this, a vector autoregression (VAR) model is employed and data analysis is carried out. Another interesting question is whether the situation affected more heavily female and the youth unemployment (under 25 years old) compared to the overall unemployment. To predict the future impact of COVID-19 on these variables, we used the Impulse Response function. Furthermore, there is taking place a comparison of the impact of the pandemic with the other European countries for overall, female, and youth unemployment rates. Finally, the forecasting ability of such a model is compared with ARIMA and ANN univariate models.

Sign in / Sign up

Export Citation Format

Share Document