The Shaping Long-Term Care in America NIA funded program project grant (PPG) [P0-1-AG- 27296] being conducted at the Brown University Center for Gerontology and Health Care Research examines how state policies and market forces affect the availability and quality of nursing home care in the US. In addition to the 4 projects being undertaken, one aim of the PPG was to make data on the structure of the US long term care (LTC) system available to potential investigators in a public use form. Brown researchers have compiled data that detail the health and functional status of nursing home residents, the characteristics of care facilities, state long term care reimbursement policies, and the characteristics of markets in which facilities exist for the period 2000 to 2010. The data, currently available on the project website http://ltcfocus.org/, can be used interactively and the entire data base can be down-loaded at the provider, county or state aggregate level, allowing researchers to address their own questions. The site has been visited nearly 20,000 times and the data downloaded by nearly 1000 people so they can explore research questions related to the supply side of the long term care market. In spite of their usefulness to date in understanding provider behavior and documenting temporal and geographic variation in US nursing homes, a whole new class of questions could be addressed were the data linked with individual level data. Since the Health and Retirement Study (HRS) is the largest and longest running national survey of the elderly population, it is an obvious extension of our efforts to make these data available to link them to the HRS. Linking residential information (i.e. zip codes, county or state codes) or provider identification numbers makes it possible to estimate the effect of market and provider characteristics (e.g quality, re-hospitalization, service mix, et.) on individuals'long term care service use choices. Similarly, county level data, such as the number of nursing home beds in the county, and state level policy data, such as the Medicaid payment rate, are available. Indeed, county and state level data can be utilized with HRS data regardless of whether they are also linked to provider files, because they provide contextual information that may influence the choices made by, and outcomes experienced by older adults. The overall goal of this data archiving proposal is to convert LTCFocus into an off the shelf module linkable to HRS restricted data files.
The specific aims of this project are to: 1) Update, clean and convert the 2000 to 2010 provider, county and state level LTCFocus data into downloadable files that can be linked with HRS data;2) Document and prepare a user manual consistent with HRS documentation standards;3) Test the final product by analyzing HRS restricted files linked to LTCFocus data and revise and deliver the final product to the HRS.
This project will prepare a newly available database describing all US nursing homes and the long term care market in which they exist over the past decade for linkage with the Health and Retirement Study (HRS) making it possible to study how the market affects elders'long term care choices.