Online Survey Certification And Reporting Research Articles

Prevalence of Warfarin Use and Concurrent Medications in Older Adults In U.S. Nursing Homes

To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes.A secondary data analysis of information from the National Nursing Home Survey (NNHS) and contemporaneous data from the Online Survey, Certification and Reporting (OSCAR) database. Data were linked by facility as the unit of analysis to determine the relationship of CNA and licensed nurse turnover on nursing home deficiencies.The 2004 NNHS used a multistage sampling strategy to generate a final sample of 1174 nursing homes, which represent 16,100 NHs in the United States.This study focused on the 1151 NNHS facilities with complete deficiency data.Turnover was defined as the total CNAs/licensed nurse full-time equivalents (FTEs) who left during the preceding 3 months (full- and part-time) divided by the total FTE. NHs with high turnover were defined as those with rates above the 75th percentile (25.3% for CNA turnover and 17.9% for licensed nurse turnover) versus all other facilities. This study used selected OSCAR deficiencies from the Quality of Care, Quality of Life, and Resident Behavior categories, which are considered to be more closely related to nursing care. We defined NHs with high deficiencies as those with numbers of deficiencies above the 75th percentile versus all others. Using SUDAAN PROC RLOGIST, we included NNHS sampling design effects and examined associations of CNA/licensed nurse turnover with NH deficiencies, adjusting for staffing, skill mix, bed size, and ownership in binomial logistic regression models.High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10–2.13), Resident Behavior (OR 1.42, 95% CI 1.03–1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12–2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50–2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25–2.33). When both CNA turnover and licensed nurse turnover were included in the same model, high licensed nurse turnover was significantly associated with Quality of Care and total deficiencies, whereas CNA turnover was not associated with that category of deficiencies.Turnover in nursing homes for both licensed nurses and CNAs is associated with quality problems as measured by deficiencies.

Improving the quality of care in nursing homes: an evidence-based approach

The landmark Nursing Home Care Reform Act of 1987 mandated basic standards of care to ensure the physical, mental, and psychosocial well-being of residents. Yet little has changed since it was enacted. High-quality facilities continue to provide good care, while poorly operated ones remain substandard. This volume offers an evidence-based framework for improving care in nursing homes. Taking a broad perspective, the authors review the history, development, and current state of care in nursing homes. After defining the concept of quality in the home, they assess an array of qualitative and quantitative statistical data to identify inconsistencies found among U.S. facilities. Individual chapters focus on varied aspects of care and the ways in which it is measured, including a thorough review of such key mechanisms as the Online Survey, Certification, and Reporting (OSCAR) data network and the Structure-Process-Outcome (SPO) model. The book also examines specific factors related to measuring and improving care, including government encouragements and sanctions, staffing policies, and the integration of technology into practice. Throughout, the authors give recommendations grounded in sound methodology and real-world experience. This service-oriented guide supplies vital tools, informed tips, and provocative ideas for professionals, students, and policy makers involved in gerontology and geriatrics.

Nursing Home Deficiency Citations for Abuse

Deficiency citations for resident abuse from U.S. nursing homes from 2000 to 2007 are examined. Deficiency citations are given to nursing homes that are in violation of Medicare/Medicaid regulations and four specific deficiency citations (representing, abuse; neglect by staff; criminal screening investigating and reporting; and, abuse prevention and policy development and implementation) were examined. The data came from the Online Survey, Certification, and Reporting (OSCAR) system data ( N = 173,219) and the analyses used generalized estimating equations. Abuse deficiency citation rates were relatively stable (from 2000 to 2007), with approximately 20% of facilities per year receiving any one of these citations. For the factors of interest, few significant findings were identified for staffing levels; whereas, a high number of deficiency citations related to quality of care, high number of the most severe deficiency citations, high Medicaid reimbursement rates, and the Medicaid occupancy/reimbursement rate interaction were significantly associated with a greater likelihood of receiving a deficiency citation for abuse.

Antidepressant Prescribing in US Nursing Homes Between 1996 and 2006 and Its Relationship to Staffing Patterns and Use of Other Psychotropic Medications

Few studies have examined factors associated with antidepressant prescribing in older nursing home residents. The primary objective was to describe the change in antidepressant prescribing for nursing home residents between 1996 and 2006. An additional objective was to examine the association between any change in antidepressant prescribing and staffing patterns or coprescribing of other psychotropic medications in the same cohort. Longitudinal. Settings were 12,556 US nursing homes in 1996 and 2006. Online Survey Certification and Reporting (OSCAR) data and the Area Resource File (ARF). Increasing prescribing of antidepressants analyzed using multivariable multinomial generalized estimating equations (GEE). Antidepressant prescribing significantly increased (P < .05) from 21.9% in 1996 to 47.5% in 2006. After controlling for resident, organizational, and market factors, increased antidepressant prescribing was associated with more time spent by physician extenders (adjusted odds ratio [AOR] 2.21; 95% confidence interval [CI] 1.96-2.51), registered nurses (AOR 1.06, 95% CI 1.02-1.10), or nurse aides (AOR 1.08; 95%CI 1.04-1.12) in a facility, as well as the coprescribing of sedative/hypnotics (AOR 1.12; 95% CI 1.08-1.16). Factors found to be protective of increasing antidepressant prescribing (ie, decrease antidepressant prescribing) included having medical directors and physicians spend more time in the facility (AOR 0.60; 95% CI 0.53-0.69 and AOR 0.62; 95% CI 0.54-0.71, respectively), or coprescribing of antianxiety or antipsychotic agents (AOR 0.70; 95% CI 0.68-0.72 and AOR 0.74; 95% CI 0.72-0.77, respectively). Prescribing of antidepressants has increased dramatically in the past decade in older nursing home residents and seems to be associated with certain staffing characteristics and the coprescribing of psychotropic medications. Further research is needed to determine if antidepressants are appropriately prescribed, and if overuse is determined, develop interventions to improve the quality of prescribing of these medications in older nursing home residents.

Do Medicaid Wage Pass‐through Payments Increase Nursing Home Staffing?

To assess the impact of state Medicaid wage pass-through policy on direct-care staffing levels in U.S. nursing homes. Online Survey Certification and Reporting (OSCAR) data, and state Medicaid nursing home reimbursement policies over the period 1996-2004. A fixed-effects panel model with two-step feasible-generalized least squares estimates is used to examine the effect of pass-through adoption on direct-care staff hours per resident day (HPRD) in nursing homes. A panel data file tracking annual OSCAR surveys per facility over the study period is linked with annual information on state Medicaid wage pass-through and related policies. Among the states introducing wage pass-through over the study period, the policy is associated with between 3.0 and 4.0 percent net increases in certified nurse aide (CNA) HPRD in the years following adoption. No discernable pass-through effect is observed on either registered nurse or licensed practical nurse HPRD. State Medicaid wage pass-through programs offer a potentially effective policy tool to boost direct-care CNA staffing in nursing homes, at least in the short term.

Prevalence of Nursing Assistant Training and Certification Programs Within Nursing Homes, 1997-2007

The purpose of this study was to describe how the prevalence of nurse aide training and competency evaluation programs (NATCEPs) provided in the nursing home (NH) setting changed between 1997 and 2007, to explore the environmental factors that may be influencing the prevalence of these programs, and to examine how the changing prevalence of NH-based NATCEPs may be affecting those considering certified nursing assistant (CNA) work. We used the Online Survey Certification and Reporting (OSCAR) data to generate descriptive statistics for 3 groups of NHs from 1997 to 2007: NHs that never provided an NATCEP, those that provided the program throughout the study period, and those that provided the program intermittently. We gathered information on states' policies regarding CNA training by telephone and Internet. Data from the National Nursing Assistant Survey were also utilized to describe where CNAs are receiving their training and what proportion of costs they are paying. Prevalence of NH-based programs dropped throughout the study period. It is likely that most CNAs are now receiving their preemployment training outside the NH setting and paying a greater share of their training costs. The shifting of CNA training to venues other than NHs raises important questions about the quality of training and states' ability to monitor training programs. In addition, CNAs receiving training outside NHs pay a greater share of their training costs, possibly creating a disincentive to enter the field.

Nursing home quality: does financial performance matter?

This study explores the relationship between financial condition and selected quality measures for 1,197 nursing homes in Florida. Data sources included the Online Survey, Certification and Reporting (OSCAR) data reports and the Center for Medicare and Medicaid Services (CMS) Medicare cost report from 2002-2005. Quality measures included surveyor-reported deficiencies and facility-reported incidents of urinary catheterisation, restraint use, and pressure sores. The study conducted multivariate regression analyses using a cross-sectional time series generalised estimating equation (GEE) model to examine the effect of nursing home financial performance on each of these quality measures. Nursing homes in the lowest financial performance category had significantly higher total deficiencies, higher rates of catheterisation and higher incidences of pressure sores when compared to top performers. Policymakers need to closely monitor the financial performance of these poorest performers to ensure that they can survive financially while ensuring a safe environment and delivery of high quality care.

The Unintended Consequences of Staffing Mandates in Florida Nursing Homes: Impacts on Indirect-Care Staff

Research on nursing staff ratios and quality of care in nursing homes prompted Florida to implement minimum nursing staff ratios for certified nursing assistants (CNAs) in 2001. Using the contingency theory, the authors investigated the response to this mandate and its potential effects on indirect-care staff. This study used the Online Survey, Certification, and Reporting (OSCAR) staffing data for freestanding Florida nursing homes between the years 1999 and 2004. Piecewise regression growth curve models were investigated to test whether the percentage of Medicaid residents is associated with change in indirect-care staffing levels. The number of indirect-care staff hours per 100 residents declined significantly following the mandated increase in nursing staff, particularly among facilities with a low percentage of Medicaid residents. This may have stemmed from a partial transfer of indirect-care to CNAs and was exacerbated in facilities that received less additional reimbursement to pay for CNA increases.

Medical Staff Organization in Nursing Homes: Scale Development and Validation

To construct a multidimensional self-report scale to measure nursing home (NH) medical staff organization (NHMSO) dimensions and then pilot the scale using a national survey of medical directors to provide data on its psychometric properties. Instrument development process consisting of the proceedings from the Nursing Home Physician Workforce Conference and focus groups followed by cognitive interviews, which culminated in a survey of a random sample of American Medical Directors Association (AMDA) affiliated medical directors. Analyses were conducted on surveys matched to Online Survey Certification and Reporting (OSCAR) data from freestanding nonpediatric nursing homes. A total of 202 surveys were available for analysis and comprised the final sample. Dimensions were identified that measured the extent of medical staff organization in nursing homes and included staff composition, appointment process, commitment (physiciancohesion; leadership turnover/capability), departmentalization (physician supervision, autonomy and interdisciplinary involvement), documentation, and informal dynamics. The items developed to measure each dimension were reliable (Cronbach's alpha ranged from 0.81 to 0.65).Intercorrelations among the scale dimensions provided preliminary evidence of the construct validity of the scale. This report, for the first time ever, defines and validates NH medical staff organization dimensions, a critical first step in determining the relationship between physician practice and the quality of care delivered in the NH.

Reliability Estimates of Clinical Measures Between Minimum Data Set and Online Survey Certification and Reporting Data of US Nursing Homes

Evidence-based quality improvement in nursing homes relies heavily on administrative data. Minimum Data Set (MDS) and Online Survey Certification and Reporting (OSCAR) are the 2 largest sources of national nursing home administrative data. Although clinical measures in each of the data systems have frequently and independently been used to measure nursing home performance, no study has systematically examined their relative reliability. This study estimates the reliability of clinical measures between MDS and OSCAR data and discusses the utility of these databases in research. We analyzed 4 waves of national MDS and OSCAR data (1999-2002). A comparable group of 24 clinical indicators from both datasets was selected for the reliability test. Spearman rank-order correlation analyses were used to measure the test-retest reliability relationships. Across the 4 years, the majority of coefficients of clinical measures exhibit good reliability. There are 17 clinical measures (71% of the total measures) with correlation coefficients greater than 0.4, the minimally acceptable reliability threshold according to Morris. The highest correlation coefficients were associated with tube feeding at 0.883. Our findings indicate that the target clinical measures in OSCAR and MDS are generally consistent and reliable. However, researchers should use OSCAR self-reported clinical measures to measure nursing home outcomes in place of corresponding MDS clinical measures with caution because some indicators in the administrative data are more reliable than others.

No Harm Found in Equity Ownership

Quality of care does not decline when private equity firms buy up nursing home chains and individual nursing homes, according to an analysis of federal data by researchers at Harvard Medical School, Boston. David Stevenson, PhD, and David Grabowski, PhD, identified 1,554 U.S. nursing homes purchased by private equity firms from 2000 to 2007, all but 82 of which were part of whole-chain deals (Health Affairs 2008;27:1399–408). They defined private equity ownership as investments not tradable on public markets. For quality of care data, the team combed the Centers for Medicare & Medicaid Services' Online Survey, Certification, and Reporting (OSCAR) system and Minimum Data Set (MDS) Quality Indicator/Quality Measure (QI/QM) system. OSCAR offered broad measures of homes' staffing, resident characteristics, and inspection outcomes. The MDS QI/QM data provided quarterly measures of residents' health status. That status included numbers on facilities' catheter use, urinary tract infections, excessive weight loss, time in bed or a chair, deficits in activities of daily living, range of motion decline, physical restraints, and pressure sores. Although numbers of registered nurses declined, nurse aide staffing increased after the sales. The analysis also linked equity ownership to reduced numbers of Medicaid beneficiaries in facilities. Although the unadjusted data showed that facilities acquired by private equity interests performed worse on most measures than most for-profit homes, adjusting for trends starting before ownership changes of the facilities, Dr. Stevenson and Dr. Grabowski found improvements with private equity ownership in catheter use, urinary tract infections, weight loss, and pressure ulcers. “We found little evidence to suggest that nursing home quality worsens significantly following purchase by private equity companies,” they wrote. “Although our findings suggest troubling declines in RN staffing, this decline was part of a larger trend that predated the facilities' purchase by private equity companies,” wrote the researchers. Yet the researchers raised cautions about private equity ownership. Their reservations included: ▸ Private investors may have limited experience in providing nursing home care. ▸ The complex ownership and liability structures often set up can limit accountability for quality. ▸ The large debts incurred by firms, especially in purchases of nursing home chains, could at some point limit operating funds. ▸ Private equity companies are more concerned with short-term financial performance of nursing homes—in hopes of lucrative resale of these assets—than long-term operations. In an interview, Dr. Stevenson said that the study doesn't prove that private equity ownership of nursing homes is beneficial or even harmless. The phenomenon of private equity ownership is still too young to show its effects definitively, he said. Now, the economy's ongoing credit crunch is slowing down deals, with none having occurred since The Carlyle Group purchased the HCR ManorCare chain of homes a year ago, he added. Dr. Stevenson admitted that OSCAR data provide only a proxy for quality of care, and that many professionals object to its underlying survey process. On the other hand, he said that MDS QI/QO data “have been shown to be pretty reliable on functional status and quality.” He explained that he and Dr. Grabowski adjusted the data to reflect quality and case-mix trends already occurring at the nursing homes before purchase and so, if they remained on the same trajectory, these trends couldn't be attributable to ownership change. Dr. Stevenson said that neither he nor Dr. Grabowski had any conflict of interest regarding the study. Keith Haglund is publication editor of Caring for the Ages.

Not So Black and White: Nursing Home Concentration of Hispanics Associated with Prevalence of Pressure Ulcers

To examine the association between the nursing home (NH) concentration of Hispanics and prevalence of pressure ulcer. Secondary data analysis using data from the national repository of the 2000 Minimum Data Set (MDS) and On-Line Survey Certification and Reporting (OSCAR) data. We used a multivariate logistic model, with the Huber-White correction to account for clustering of persons within a nursing facility, to examine the association of Hispanic NH concentration with the prevalence of pressure ulcers, after adjusting for resident level characteristics. Five states with a high population of Mexican-Americans (California, New Mexico, Arizona, Colorado, and Texas). A total of 74,343 persons (9.26% black, 11.28% Hispanic, 79.46% non-Hispanic white) in a NH located in 1 of these 5 states during the last quarter of 2000. The prevalence of Stage II-IV pressure ulcers was examined in the last quarter of 2000. Stage II-IV pressure ulcers, resident demographics, and medical illness data were documented by nursing staff on the MDS. Hispanics and non-Hispanic blacks had a higher prevalence of pressure ulcers than non-Hispanic whites (7.60%, 9.71% and 12.10%, respectively). A facility's concentration of Hispanic residents was associated with prevalent pressure ulcers after adjustment for resident characteristics. Residents in nursing homes in which there is a higher concentration of Hispanic residents are more likely to have a pressure ulcer.

Certified Nursing Assistants' Perceptions of Nursing Home Patient Safety Culture: Is There a Relationship to Clinical Outcomes?

The main objective of this study was to examine whether certified nursing assistants' (CNAs') perceptions of patient safety culture (PSC) were correlated with clinical outcomes (rates of falls, pressure ulcers, and daily restraint use) in a random sample of nursing homes. An additional objective was to describe facility-level and CNA-level characteristics that were associated with CNA PSC scores. We conducted a secondary data analysis using data that adapted the Hospital Survey of Patient Safety Culture (HSOPSC) for nursing homes. The HSOPSC data were merged with data from the Minimum Data Set (MDS), Online Survey Certification and Reporting (OSCAR) system, and Area Resource File (ARF). CNAs from a random sample of 72 nursing homes in 5 randomly selected states during the first 2 quarters of 2005. The relationships between clinical outcomes and CNA PSC scores were evaluated. The relationships between CNA PSC and facility characteristics, such as profit status and bed occupancy, and CNA characteristics such as education and tenure were also assessed. Data were analyzed using Poisson, multinomial logistic, and linear regression, and generalized estimating equations (GEE); descriptive statistics were compiled for demographic data. Of 2872 CNAs, 1579 completed the survey, for a 55% response rate. Results of regression analyses suggest that higher (more developed and more desirable) CNA PSC scores were associated with increased reporting of falls (B = 0.015; P = .000). Facilities with higher total CNA PSC scores were more likely to report moderate restraint use, whereas facilities with lower CNA PSC scores were more likely to report high restraint use (B = 0.172; P = .017). CNA PSC scores were not associated with differences in pressure ulcer rates. This study represents an important step in the evaluation of CNA PSC in nursing homes and shows that a relationship exists between PSC and selected clinical outcomes. Future work on nursing home PSC and additional clinical as well as workforce outcomes is indicated.

Successfully Managing Attending Physicians

Successfully Managing Attending Physicians

The Staffing–Outcomes Relationship in Nursing Homes

To assess longitudinally whether a change in registered nurse (RN) staffing and skill mix leads to a change in nursing home resident outcomes while controlling for the potential endogeneity of staffing. Minimum Data Set (MDS) nursing home resident assessment data from five states merged with Online Survey Certification and Reporting (OSCAR) data from 1996 through 2000. Resident-level longitudinal analysis with facility fixed effects and instrumental variables. Outcomes studied are incidence of pressure sores and urinary tract infections. RN staffing was measured as the care hours per resident-day and skill mix was measured as RN staffing hours as a proportion of total staffing hours. We use all quarterly MDS assessments that fall within 120 days of an annual OSCAR data point, resulting in 399,206 resident-level observations. Controlling for endogeneity of staffing increases the estimated impact of staffing on outcomes in nursing homes. Greater RN staffing significantly decreases the likelihood of both adverse outcomes. Increasing skill mix only reduces the incidence of urinary tract infections. Research that fails to account for endogeneity of the staffing-outcomes relationship may underestimate the benefit from increased RN staffing. Increases in RN staffing are likely to reduce adverse outcomes in some nursing homes. More research using a broader array of instruments and a national sample would be beneficial.

Comparing Staffing Levels in the Online Survey Certification and Reporting (OSCAR) System With the Medicaid Cost Report Data: Are Differences Systematic?

This study had two goals: (a) to assess the validity of the Online Survey Certification and Reporting (OSCAR) staffing data by comparing them to staffing measures from audited Medicaid Cost Reports and (b) to identify systematic differences between facilities that over-report or underreport staffing in the OSCAR. We merged the 2002 Texas Nursing Facility Cost Report, the OSCAR for Texas facilities surveyed in 2002, and the 2003 Area Resource File. We eliminated outliers in the OSCAR using three decision rules, resulting in a final sample size of 941 of the total of 1,017 non-hospital-based facilities. We compared OSCAR and Medicaid Cost Report staffing measures for three staff types. We examined differences between facilities that over-reported or underreported staffing levels in the OSCAR by using logistic regression. Average staffing levels were higher in the OSCAR than in the Medicaid Cost Report data. The two sets of measures exhibited correlations ranging between 0.5 and 0.6. For-profit and larger facilities consistently over-reported registered nurse staffing levels. Factors associated with increased odds of over-reporting licensed vocational nursing or certified nursing assistant staffing were lower Medicare or Medicaid censuses and less market competition. Facility characteristics associated with over-reporting were consistent across different levels of over-reporting. Underreporting was much less prevalent. Certain types of facilities consistently over-report staffing levels. These reporting errors will affect the validity of consumer information systems, regulatory activities, and health services research results, particularly research using OSCAR data to examine the relationship between staffing and quality. Results call for a more accurate reporting system.

The Smart-Seller Challenge: Exploring the Determinants of Privatizing Public Nursing Homes

This study investigates the determinants of local governments' decisions to privatize public nursing homes. According to the Online Survey, Certification, and Reporting (OSCAR) 2004 data, more than 100 counties in the United States have recently divested their nursing facilities through change of ownership to nonprofit or for profit or through termination. The theoretical model used in this study proposes four broad categories of antecedents of the privatization decision: market failure, government failure, and monetary and institutional factors. County governments are viewed as rational actors, affected by a range of external and internal pressures and striving to maximize the attainment of their complex missions. The data used in this study come from the OSCAR 2004 file and several other sources. Using logistic regression analysis, the baseline (1998-2000) measures of all independent variables for 622 county-owned homes were regressed on the dummy dependent variable, indicating whether the nursing home was privatized by 2003 or not. Quantitative analysis was supplemented with two exploratory case studies. Local market competition, occupancy level, condition of the physical plant, staffing, the prevalence of privatization in the neighboring counties, and the proportion of elderly in the county were found to be significantly associated with the likelihood of nursing home divestment. The analysis supports the idea of a complex framework of managerial decision making: counties appear to be smart sellers by divesting when occupancy declines, when the physical environment deteriorates, and when private markets are relatively more competitive. They are also found to be smart owners by sustaining public ownership of thriving public facilities surrounded by failing private markets.

Doing better to do good: the impact of strategic adaptation on nursing home performance.

To test the hypothesis that a greater commitment to strategic adaptation, as exhibited by more extensive implementation of a subacute/rehabilitation care strategy in nursing homes, will be associated with superior performance. Online Survey, Certification, and Reporting (OSCAR) data from 1997 to 2004, and the area resource file (ARF). The extent of strategic adaptation was measured by an aggregate weighted implementation score. Nursing home performance was measured by occupancy rate and two measures of payer mix. We conducted multivariate regression analyses using a cross-sectional time series generalized estimating equation (GEE) model to examine the effect of nursing home strategic implementation on each of the three performance measures, controlling for market and organizational characteristics that could influence nursing home performance. DATA COLLECTION/ABSTRACTION METHODS: OSCAR data was merged with relevant ARF data. The results of our analysis provide strong support for the hypothesis. From a theoretical perspective, our findings confirm that organizations that adjust strategies and structures to better fit environmental demands achieve superior performance. From a managerial perspective, these results support the importance of proactive strategic leadership in the nursing home industry.

Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.

To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates. Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources. Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix. RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors. To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours.

Nursing Home Consumer Complaints and Quality of Care: A National View

This study uses 5 years of national data on investigated nursing home complaints (1998-2002) to evaluate whether complaints might be used to assess nursing home quality of care. On-Line Survey Certification and Reporting (OSCAR) data are used to evaluate the association between consumer complaints, facility and resident characteristics, and other nursing home quality measures. The analyses are undertaken in the context of considerable cross-state variation in nursing home complaint processes and rates. Complaints varied across facility characteristics in ways consistent with the nursing home quality literature. Complaints were significantly positively associated with survey deficiencies and the presence of serious survey deficiencies, and significantly negatively associated with nurse and nurse aide staffing. Complaints performance was significantly predictive of survey deficiencies at subsequent inspections. This study presents the first national evidence for using consumer complaints to assess nursing home quality of care. Despite limitations, nursing home complaints appear to offer a real-time signal of quality concerns.