title: Chain reaction: an exploratory study of nursing home bankruptcy in California.
abstract: This paper reports on an exploratory study of nursing home bankruptcy. From state and industry data regarding nearly 1,000 California facilities, it was possible to identify 155 homes in five chains (multi-facility organizations) that were operating in bankruptcy in 2000. When compared with facilities in non-bankrupt chains, while the bankrupt chain facilities had significantly worse financial liquidity, higher administrative costs, and higher payables to related parties, they also had more Medicare residents, fewer Medicaid residents, better solvency, and were located in less competitive county markets and in areas with higher Medicaid reimbursement rates. These findings indicate that, rather than facility characteristics and local market factors, strategic decisions taken at the corporate (chain) level are the major determinants of nursing facility bankruptcy status.
authors.affiliation: Department of Social and Behavioral Sciences, University of California, San Francisco 94118, USA. martink@itsa.ucsf.edu
authors.forename: Martin
authors.initials: M
authors.lastname: Kitchener
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'neill
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
mesh_terms: D000368:Aged; D016361:Bankruptcy / Q000706:statistics & numerical data*; D002140:California; D004465:Economic Competition; D006271:Health Facility Closure / Q000191:economics / Q000706:statistics & numerical data; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D016134:Organizational Policy; D011907:Rate Setting and Review; D014505:Urban Population