Nursing Home Regulation Research Articles

State regulation of long-term care: a decade of experience with intermediate sanctions.

Recent reforms in state nursing home regulations have created an-array of enforcement tools that relate the severity of the penalty to the severity of the violation. These intermediate sanctions, intended to be flexible and effective in enforcing state standards, include civil fines, receiverships, public disclosure, monitors. and suspension of admissions. As supplements to the more traditional remedy of license revocation, intermediate sanctions can enforce standards without closing facilities unnecessarily, thus avoiding trauma to the residents, aggravation of the shortage of nursing home beds, and lengthy administrative proceedings and litigation.The study of nursing home regulation by the Institute of Medicine of the National Academy of Sciences offers a unique opportunity to evaluate the implementation of intermediate sanctions by the states over the past decade. Because of the high degree of similarity among the state statutes authorizing these sanctions, comparisons can be drawn.

Domiciliary Care Facilities for Adults

A content analysis was conducted on ninety-eight sets of state regulations governing long-term residential facilities for adults without nursing. While most regulations contained a substantial number of physical requirements, many lacked a number of other types of requirements affecting residents' health, safety, and well-being. Sizable percentages of regulations did not include requirements in the areas of standards enforcement, staff training, services to residents, residents' rights, and relocation of residents. Regulations with more requirements were positively associated with the size of the facilities being regulated, with licensing (as opposed to certification or approval), and with regulation of facilities serving those in need of personal care, the elderly, the physically handicapped, and the mentally retarded. The number of requirements included in a set of regulations was not related to the type of state agency doing the regulating, to association with nursing home regulations, or to how recently the regulations were adopted or revised.

Community Involvement in Combating Abuse, Neglect, and Mistreatment in Nursing Homes

The existing system of nursing home regulation is often inadequate to deal with many aspects of patients' rights violations. Alternative community-involvement strategies to protect aged and disabled residents are explored. These new methods of reporting and investigating violations can be effective when combined with prudent sanctions.

How nursing homes behave: A multi-equation model of nursing home behavior

This paper estimates a multi-equation model of nursing home behavior using the 1973 NCHS National Nursing Home Survey for data. The paper investigates empirically the effects of public reimbursement and regulatory policies, as well as other exogenous factors, on the following dependent variables: (1) average operating cost; (2) nursing hours per patient-day; (3) an index of rehabilitation-type services; (4) the occupancy rate; (5) the mix of public and private patients; and (6) the rate charged to private patients. The results dramatize the importance of endogeneity concerns in nursing home behavior. Rate setting and many regulations are shown empirically to have unintended and often undesired consequences on cost and other policy criteria of interest. While there has been anecdotal evidence of such system-wide interdependencies, this study affirms that such possibilities must be taken seriously. Rational nursing home regulation cannot proceed apart from a comprehensive understanding of the nursing home behavioral environment.