title: Interaction effect of Medicaid census and nursing home characteristics on quality of psychosocial care for residents.
abstract: BACKGROUND
  Numerous studies have identified disparities in nursing home quality of care. Although previous studies have found the overlap among Medicaid census, nursing home characteristics, and negative quality of care outcomes, few studies have examined how the psychosocial well-being of nursing home residents is associated with Medicaid census and other nursing home characteristics.
  
  
  OBJECTIVE
  The purpose of this study was to elucidate the intertwined relationships between Medicaid census and other important nursing home factors and its impact on psychosocial care for residents. This study examined the interactive effects of (1) nursing home ownership status and Medicaid census, (2) staffing level and Medicaid census, and (3) resident ethnic mix and Medicaid census on psychosocial well-being outcomes.
  
  
  METHODS
  The sample, derived from a combined data set of New York State nursing homes' Online Survey Certification and Reporting System and Minimum Data Set, included 565 nursing homes in rural and urban areas of the state.
  
  
  RESULTS
  Medicaid census had no main effect on psychosocial well-being outcomes of nursing home care but had a significant interactive effect with other nursing home characteristics. High Medicaid census was associated with lower level of psychosocial symptom detection in nonprofit nursing homes and nursing homes with a higher proportion of ethnic minority residents.
  
  
  CONCLUSIONS
  Nursing staff training on better psychosocial well-being care, in particular, better psychosocial assessment, is important. To obtain the training resources, nursing homes with high Medicaid census can collaborate with other nursing homes or social service agencies. Considering that nursing homes with a high proportion of ethnic minority residents have lower level of detection rate for psychosocial well-being issues, culturally competent care should be a component of quality improvement plans.
authors.affiliation: Center for Mental Health Policy and Services Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. dooyeon@mail.med.upenn.edu
authors.forename: Christina D
authors.initials: CD
authors.lastname: Kang-Yi
authors.forename: David S
authors.initials: DS
authors.lastname: Mandell
authors.forename: Ada C
authors.initials: AC
authors.lastname: Mui
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
mesh_terms: D001294:Attitude to Health / Q000208:ethnology; D014487:Centers for Medicare and Medicaid Services, U.S.; D003863:Depression / Q000145:classification / Q000175:diagnosis; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007398:Interpersonal Relations; D016014:Linear Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D009518:New York; D009723:Nurse-Patient Relations; D009735:Nursing Homes / Q000145:classification / Q000706:statistics & numerical data; D009740:Nursing Staff / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses'; D011237:Predictive Value of Tests; D011787:Quality of Health Care / Q000592:standards*; D012051:Reimbursement Mechanisms; D012919:Social Behavior; D014481:United States; D000078329:Workforce