The proposed research focuses upon the phenomena described as the """"""""corporatization of long-term care."""""""" It is designed to better identify and define the characteristics of chain nursing homes, to document their growth, and assesses the impact of that growth upon the nursing home industry. The study will examine the differences in chain versus non-chain facilities relating these differences to long-term care costs, quality of care, and access to care. It will permit an empirical analysis of several previously untested hypotheses concerning the characteristics and behavior of chain nursing homes. These include such issues as: 1) Has the growth in chain homes contributed to escalating reimbursement costs through increased costs of capital? 2) Are chain home costs per day significantly less than non-chain costs? 3) If so, are the cost differences due to more efficient use of resources, greater flexibility in assigning staff and the opportunity for shared financial burden, or because of cream-skimming and delivery in chain versus non-chain homes, and if so, what are the implications for access to care? The analysis will utilize a unique data file which combines information from Medicare cost report files, staffing and case-mix data from the MMACS file and the Medicare chain facility file. Five tasks have been proposed: 1) Descriptive analysis of facility characteristics, costs, case-mix and staffing differences; 2) Multivariate analysis of costs (incorporating case-mix measures); 3) The role of chain homes in escalating reimbursement costs; 4) Analysis of staffing patterns; and 5) The effect of chain acquisition on individual facility capital costs.
