title: Factors associated with increasing nursing home closures.
abstract: OBJECTIVE
  We determine the rate of nursing home closures for 7 years (1999-2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures.
  
  
  METHODS
  The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States.
  
  
  RESULTS
  One thousand seven hundred and eighty-nine facilities closed over this time period (1999-2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates.
  
  
  CONCLUSIONS
  As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures.
authors.affiliation: Graduate School of Public Health, University of Pittsburgh,Pittsburgh, PA 15261, USA. castlen@Pitt.edu
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.forename: John
authors.initials: J
authors.lastname: Engberg
authors.forename: Judith
authors.initials: J
authors.lastname: Lave
authors.forename: Andrew
authors.initials: A
authors.lastname: Fisher
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data; D004465:Economic Competition; D005161:Facility Regulation and Control / Q000458:organization & administration; D006271:Health Facility Closure / Q000191:economics / Q000639:trends*; D006276:Health Facility Size / Q000706:statistics & numerical data; D006291:Health Policy; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008389:Marketing of Health Services; D008484:Medicaid / Q000458:organization & administration; D017146:Models, Organizational; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000458:organization & administration*; D009935:Organizational Affiliation / Q000706:statistics & numerical data; D010067:Ownership / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D014481:United States
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