title: Nursing Homes That Increased The Proportion Of Medicare Days Saw Gains In Quality Outcomes For Long-Stay Residents.
abstract: Nursing homes are increasingly providing rehabilitative care to short-stay residents under Medicare's skilled nursing facility coverage, which is much more generous than Medicaid's coverage for long-stay residents. This shift creates the potential for both beneficial and detrimental effects on outcomes for such residents. Examining nationwide facility-level nursing home data for the period 2007-10, we found that increasing the proportion of Medicare-covered patient days in a nursing home was significantly associated with improvements in the quality of the three outcomes we considered for long-stay residents. We saw significant decreases in the percentages of long-stay residents with daily pain (from 5.1 percent to 3.4 percent), with worsening pressure ulcers (from 2.5 percent to 2.0 percent), and with a decline in performing activities of daily living (from 15.9 percent to 14.9 percent). These findings reinforce previous research indicating that quality outcomes tend to be superior in nursing homes with greater financial resources. They also bolster arguments for financial investments in nursing homes, including increases in Medicaid payment rates, to support better care for long-stay residents.
authors.affiliation: Michael Lepore (mlepore@rti.org) is a senior health policy and health services researcher in the Aging, Disability, and Long-Term Care program at RTI International in Washington, D.C., and an adjunct assistant professor in the Department of Health Services, Policy, and Practice at Brown University, in Providence, Rhode Island.
authors.forename: Michael
authors.initials: M
authors.lastname: Lepore
authors.affiliation: Natalie E. Leland is an assistant professor with a joint appointment in the Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy and the Davis School of Gerontology at the University of Southern California, in Los Angeles, and an adjunct assistant professor in the Department of Health Services, Policy, and Practice at Brown University.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Leland
mesh_terms: D016208:Databases, Factual; D006801:Humans; D007902:Length of Stay; D006278:Medicare; D009735:Nursing Homes / Q000191:economics; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D011787:Quality of Health Care; D014481:United States
keywords: Long-Term Care; Medicaid; Medicare