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 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.

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.

CMS Mega-Rule Update and the Status of Pharmacy-Related Deficiencies in Nursing Homes

2020 ◽  
pp. 073346482096758
Author(s):  
Kathryn W. Wesson ◽  
Krista L. Donohoe ◽  
Julie A. Patterson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Drug Regimen ◽  
Pharmacy Services ◽  
For Profit ◽  
The Status ◽  
Profit Status ◽  
Pharmacist Services

The scope, frequency, and nursing home characteristics associated with pharmacy-related deficiency citations following the Centers for Medicare and Medicaid Services 2016 “Mega-Rule” update are described. A retrospective analysis of data from Nursing Home Compare and LTCfocus.org was conducted on pharmacy-related deficiencies (including pharmacy services, drug regimen review, unnecessary medications, medication errors, and labeling/storage). The most commonly cited pharmacy-related deficiencies ( N = 11,678) were related to labeling/storage (comprising 25.1% of pharmacy-related deficiencies), unnecessary psychotropic medications (20.5%), and routine pharmacy services (16.8%). In multivariable analysis, nursing home characteristics significantly associated with receiving any pharmacy-related deficiency included less geographic competition (adjusted odds ratio [aOR]: 0.68), registered nurse hours (aOR: 0.66), occupancy (aOR: 0.67), for-profit status (aOR: 1.27), and Midwest (aOR: 1.50) or West (aOR: 2.95) location. Given the frequency of pharmacy-related citations and the lack of standardization in pharmacists’ roles in nursing homes, further research is needed to better understand how pharmacist services can affect inspection compliance.

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.

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 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.

The Increasing Prevalence of Obesity in Residents of U.S. Nursing Homes: 2005–2015

2019 ◽  
Vol 74 (12) ◽  
pp. 1929-1936 ◽  
Author(s):  
Ning Zhang ◽  
Terry Field ◽  
Kathleen M Mazor ◽  
Yanhua Zhou ◽  
Kate L Lapane ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Normal Weight ◽  
Data Sets ◽  
Obesity Prevalence ◽  
Class Iii ◽  
Mobility Impairment ◽  
Functional Characteristics ◽  
Minimum Data

Abstract Background Obesity prevalence has been increasing over decades among the U.S. population. This study analyzed trends in obesity prevalence among long-stay nursing home residents from 2005 to 2015. Methods Data came from the Minimum Data Sets (2005–2015). The study population was limited to long-stay residents (ie, those residing in a nursing home ≥100 days in a year). Residents were stratified into body mass index (BMI)-based groups: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30); residents with obesity were further categorized as having Class I (30 ≤ BMI < 35), Class II (35 ≤ BMI < 40), or Class III (BMI ≥ 40) obesity. Minimum Data Sets assessments for 2015 were used to compare clinical and functional characteristics across these groups. Results Obesity prevalence increased from 22.4% in 2005 to 28.0% in 2015. The prevalence of Class III obesity increased from 4.0% to 6.2%. The prevalence of underweight, normal weight, and overweight decreased from 8.5% to 7.2%, from 40.3% to 37.1%, and from 28.9% to 27.8%, respectively. In 2015, compared with residents with normal weight, residents with obesity were younger, were less likely to be cognitively impaired, had high levels of mobility impairment, and were more likely to have important medical morbidities. Conclusions and Relevance There was a steady upward trend in obesity prevalence among nursing home residents for 2005–2015. Medical and functional characteristics of these residents may affect the type and level of care required, putting financial and staffing pressure on nursing homes.

Illusions of Affection: Bureaucratic Ritualization's Relation to Emotional Abuse and Neglect in Nursing Homes

2009 ◽  
Vol 33 (3) ◽  
pp. 238-257 ◽  
Author(s):  
Jason S. Ulsperger ◽  
J. David Knottnerus
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Emotional Abuse ◽  
Nursing Home Residents ◽  
For Profit ◽  
The Poor ◽  
Structural Ritualization Theory ◽  
Abuse And Neglect ◽  
Poor Treatment ◽  
Everyday Interaction

This research uses 40 ethnographies, biographies, and autobiographies to explore various symbolic themes expressed through everyday interaction in nursing homes. The themes involve bureaucratic concepts such as staff separation, rules, documentation, and efficiency. They also involve ideas of emotional abuse and neglect, like objectification, compassion transgressions, and spiritual negligence. Relying on structural ritualization theory, we argue ritualized symbolic practices of bureaucracy unintentionally facilitate attitudes and acts of emotional neglect in both for-profit and nonprofit nursing homes. This assists in the development of rituals facilitating the poor treatment of residents. Overall, we propose that if society is going to have humane care for nursing home residents, it must first understand the ritual dynamics that lead to employees viewing and treating those they care for with a lack of dignity.

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