Abstract
BackgroundAvailability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. We sought to assess geographic variation in availability and quality of nursing home care.MethodsRetrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996–2016. Outcomes were 1) availability of all nursing home care (1996–2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged ≥65 years, regardless of nursing home star rating; 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes; and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds.ResultsFrom 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged ≥65 years. Persistent geographic variation in availability of nursing home care was observed; the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77–0.79). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged ≥65 years. The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51–0.56). Availability and quality of nursing home care were not highly correlated. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30–0.36). From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division.ConclusionWe observed persistent geographic variations in availability and quality of nursing home care. Availability of all nursing home care declined but availability of 5-star nursing home care increased. Availability and quality of nursing home care were not highly correlated.
Highlights
Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time
To assess the relationship between availability of all nursing home care and availability of 5-star nursing home care, we modeled the availability of all nursing home care as a function of 5-star nursing home care, adjusted for county-specific characteristics and time and stratified by regions
In 2016, the median number of Medicaid/Medicare-certified years of a nursing home in business was 26 (20–36), 30.4% of nursing homes were not-for-profit ownership, 4.4% were in a rural area, and 93.4% were certified by both Medicaid and Medicare
Summary
Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. 30% (1.5 million) of hospitalized Medicare beneficiaries are referred to nursing homes at hospital discharge [4]. Nursing home care is associated with shorter hospital stays and lower hospital costs and has been reported to improve patients’ health and quality of life, and lower rates of unplanned readmissions [5,6,7,8,9,10,11,12]. Given the importance of nursing homes, national efforts have been initiated to monitor and improve the quality of such care. The Centers for Medicare & Medicaid Services (CMS) launched the Five-Star Quality Rating System in 2008 to publicly report nursing home performance [13,14,15]. High star-rated nursing homes represent high quality of care and studies found that these nursing homes gain more residents [16,17,18,19]
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