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.

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 Compress the curve: a cross-sectional study of variations in COVID-19 infections across California nursing homes

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042804
Author(s):  
Ram Gopal ◽  
Xu Han ◽  
Niam Yaraghi
Keyword(s):  
Nursing Homes ◽  
Cross Sectional Study ◽  
The State ◽  
Cross Sectional ◽  
Term Care ◽  
Policy Makers ◽  
Non Profit ◽  
For Profit ◽  
The Us

ObjectiveNursing homes’ residents and staff constitute the largest proportion of the fatalities associated with COVID-19 epidemic. Although there is a significant variation in COVID-19 outbreaks among the US nursing homes, we still do not know why such outbreaks are larger and more likely in some nursing homes than others. This research aims to understand why some nursing homes are more susceptible to larger COVID-19 outbreaks.DesignObservational study of all nursing homes in the state of California until 1 May 2020.SettingThe state of California.Participants713 long-term care facilities in the state of California that participate in public reporting of COVID-19 infections as of 1 May 2020 and their infections data could be matched with data on ratings and governance features of nursing homes provided by Centers for Medicare & Medicaid Services (CMS).Main outcome measureThe number of reported COVID-19 infections among staff and residents.ResultsStudy sample included 713 nursing homes. The size of outbreaks among residents in for-profit nursing homes is 12.7 times larger than their non-profit counterparts (log count=2.54; 95% CI, 1.97 to 3.11; p<0.001). Higher ratings in CMS-reported health inspections are associated with lower number of infections among both staff (log count=−0.19; 95% CI, −0.37 to −0.01; p=0.05) and residents (log count=−0.20; 95% CI, −0.27 to −0.14; p<0.001). Nursing homes with higher discrepancy between their CMS-reported and self-reported ratings have higher number of infections among their staff (log count=0.41; 95% CI, 0.31 to 0.51; p<0.001) and residents (log count=0.13; 95% CI, 0.08 to 0.18; p<0.001).ConclusionsThe size of COVID-19 outbreaks in nursing homes is associated with their ratings and governance features. To prepare for the possible next waves of COVID-19 epidemic, policy makers should use these insights to identify the nursing homes who are more likely to experience large outbreaks.

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 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 Roles of the Water Court and the State Engineer for water administration in Colorado

Water Policy ◽  
2017 ◽  
Vol 19 (5) ◽  
pp. 837-850 ◽  
Author(s):  
William C. McIntyre ◽  
David C. Mays
Keyword(s):  
State Government ◽  
Water Policy ◽  
Water Rights ◽  
The United States ◽  
The State ◽  
The Us ◽  
State Engineer ◽  
History Of ◽  
Water Administration ◽  
Civil Courts

Colorado manages water using an administrative structure that is unique among the United States following the doctrine of prior appropriation: Water rights are adjudicated not by the State Engineer, but by Water Courts – separate from and operating in parallel to the criminal and civil courts – established specifically for this purpose. Fundamental to this system is the notion that water rights are property, with consequent protections under the US Constitution, but with the significant constraint that changes in water rights must not injure other water rights, either more senior or more junior. Population growth and climate change will certainly trigger changes in water administration, to be guided by the recent Colorado Water Plan. To provide the foundation necessary to appreciate these changes, this paper reviews the history of Colorado water administration and summarizes the complementary roles of the Water Courts and the State Engineer. Understanding water administration in Colorado depends on a firm grasp on how these two branches of state government formulate and implement water policy.

The American War in Afghanistan

2021 ◽  
Author(s):  
Carter Malkasian
Keyword(s):  
United States ◽  
Decision Making ◽  
The United States ◽  
State Building ◽  
The State ◽  
The Us ◽  
History Of ◽  
Narrative Format

The American War in Afghanistan is a full history of the war in Afghanistan between 2001 and 2020. It covers political, cultural, strategic, and tactical aspects of the war and details the actions and decision-making of the United States, Afghan government, and Taliban. The work follows a narrative format to go through the 2001 US invasion, the state-building of 2002–2005, the Taliban offensive of 2006, the US surge of 2009–2011, the subsequent drawdown, and the peace talks of 2019–2020. The focus is on the overarching questions of the war: Why did the United States fail? What opportunities existed to reach a better outcome? Why did the United States not withdraw from the war?

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 The Impact of the US Financial Crisis on How Students Pay for College

2015 ◽  
Author(s):  
Arthur M. Hauptman
Keyword(s):  
The United States ◽  
Public Institutions ◽  
Federal Financial Aid ◽  
For Profit ◽  
American Students ◽  
The Us ◽  
Home Values ◽  
The Impact ◽  
Private Loan ◽  
Us Financial Crisis

The 2008 failure of major financial institutions in the United States may have dramatic ramifications on American students and whether/where they attend college. Several sources of funding may be at risk, including potential decreases in federal financial aid, the tightening of private loan availability, lowered home values impinging on equity-based lending, and stock market losses in college-fund savings. Public institutions, whose tuition is much lower than private or for-profit institutions, may see an increase in enrollment.

scholarly journals On the ethics of doctors in capitalist countries

1981 ◽  
Vol 62 (5) ◽  
pp. 80-83
Author(s):  
S. Ya. Chikin
Keyword(s):  
United States ◽  
Surgical Intervention ◽  
The United States ◽  
For Profit ◽  
Us Congress ◽  
The Us ◽  
The Cost

In 1977, the US Congress published statistics on the operation of surgical clinics in many cities in the country. These materials cannot be read without a shudder. They once again proved that American doctors are no different from businessmen in their passion for profit. The report's conclusion was very sad. He testified that up to three million unjustified surgeries are performed annually in the United States. Naturally, they are not undertaken for the sake of the patient's health, but in order to present a more weighty bill to the patient, because the cost of the simplest surgical intervention is now estimated at at least $ 1000.

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