Substandard nursing home quality and inadequate nurse staffing have been persistent concerns for long term care policy makers over the last three decades. In spite of this history and the increasing case-mix complexity of the nursing home population, compounded by universal nursing shortages, the majority of states plan reductions, or at least freezes, in Medicaid spending in response to record budgetary shortfalls due to declining tax revenues. The effect this may have on nursing home quality is unclear because the empirical literature has been mixed regarding the inter-relationship of factors such as Medicaid payment levels, staffing, and nursing home quality. Using newly available, national data bases covering a period of substantial volatility in Medicaid payment rates and policies (1998-2004) which integrate resident level clinical outcomes data, organizational level staffing and payer mix data with county and state data for the entire country, we propose: 1.To test the effect of changes in state-level Medicaid payment rates on nursing home skilled and unskilled staffing levels; 2.To test the effect of changes in facility-level staffing on various patient-level, risk-adjusted, nursing home quality measures; 3.To test the effect of changes in Medicaid payment rates on patient-level, risk-adjusted nursing home quality measures; and, 4.To test whether the responses to changes in Medicaid rates are similar in facilities with a disproportionately large minority population, high concentration of Medicaid residents, and private pay residents. Hypotheses addressing each aim will be tested using fixed effects models that assess the impact of payment rate changes holding facility and market characteristics constant and using multi-level models that specify which changing features of the facility and the market change along with Medicaid payment rates. Sensitivity analyses will seek to isolate those types of facilities and markets most and least likely to be responsive to changes in Medicaid payment rates in order to guide policy discussions about this important issue over the coming decade. Our results will allow providers, advocates, clinicians, consumers and policymakers to better evaluate the effects of current nursing home policies regarding payment rates and staffing mandates, build upon the strengths of such policies and suggest alternative, more focused, strategies.
| Grabowski, David C; Feng, Zhanlian; Intrator, Orna et al. (2010) Medicaid bed-hold policy and Medicare skilled nursing facility rehospitalizations. Health Serv Res 45:1963-80 |
| Intrator, Orna; Schleinitz, Mark; Grabowski, David C et al. (2009) Maintaining continuity of care for nursing home residents: effect of states' Medicaid bed-hold policies and reimbursement rates. Health Serv Res 44:33-55 |
| Grabowski, David C; Aschbrenner, Kelly A; Feng, Zhanlian et al. (2009) Mental illness in nursing homes: variations across States. Health Aff (Millwood) 28:689-700 |
| Feng, Zhanlian; Hirdes, John P; Smith, Trevor F et al. (2009) Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study. Int J Geriatr Psychiatry 24:1110-8 |
| Zinn, Jacqueline; Mor, Vincent; Feng, Zhanlian et al. (2009) Determinants of performance failure in the nursing home industry. Soc Sci Med 68:933-40 |
| Gruneir, Andrea; Miller, Susan C; Feng, Zhanlian et al. (2008) Relationship between state medicaid policies, nursing home racial composition, and the risk of hospitalization for black and white residents. Health Serv Res 43:869-81 |
| Feng, Zhanlian; Grabowski, David C; Intrator, Orna et al. (2008) Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004. Med Care 46:33-40 |
| Gruneir, Andrea; Lapane, Kate L; Miller, Susan C et al. (2008) Is dementia special care really special? A new look at an old question. J Am Geriatr Soc 56:199-205 |
| Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent et al. (2008) Restructuring in response to case mix reimbursement in nursing homes: a contingency approach. Health Care Manage Rev 33:113-23 |
| Gruneir, Andrea; Mor, Vincent (2008) Nursing home safety: current issues and barriers to improvement. Annu Rev Public Health 29:369-82 |
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