Christine E. Bishop

Impact of Special Care Unit for Patients with Advanced Alzheimer's Disease on Patients' Discomfort and Costs

Objective: To compare outcomes in patients with the clinical diagnosis of probable dementia of the Alzheimer type (DAT) cared for in a Dementia Special Care Unit (DSCU) with those in traditional long‐term care (TLTC).

Competition in the Market for Nursing Home Care

The competitive model may fit the nursing home sector better than it fits other health care markets, but Medicaid subsidies and regulation have not allowed the market to work freely, and nursing home insurance may cause further divergence from a competitive ideal. Incentives for both providers and consumers that capitalize on competitive aspects of the market might be used to improve outcomes of the nursing home market, especially under a system of comprehensive long-term care insurance.

Why Do Nursing Home Costs Vary? The Determinants of Nursing Home Costs

Since the costs of nursing home care are a major component of the rapidly rising costs of health care, it is appropriate to base public policy discussions about cost containment on the determinants of nursing home costs. This article investigates the determinants of nursing home operating costs and reviews the results of 11 related econometric cost analyses conducted by the authors. Single-equation cost analyses are developed for nursing homes in three states and in the nation. The cost results of a multi-equation model of nursing home behavior are also reviewed. The analyses indicate that facility size and occupancy rate are minimally important in determing cost variation. Facility characteristics, particularly type of facility and ownership, are important variables. Nonprofit facilities consistently had higher costs than for-profit facilities, after controlling for patient mix and service differences, and, in one analysis, for a measure of quality.

How nursing homes behave: a multi-equation model of nursing home behavior.

This paper estimates a multi-equation model of nursing home behavior using the 1973 NCHS National Nursing Home Survey for data. The paper investigates empirically the effects of public reimbursement and regulatory policies, as well as other exogenous factors, on the following dependent variables: (1) average operating cost; (2) nursing hours per patient-day; (3) an index of rehabilitation-type services; (4) the occupancy rate; (5) the mix of public and private patients; and (6) the rate charged to private patients. The results dramatize the importance of endogeneity concerns in nursing home behavior. Rate setting and many regulations are shown empirically to have unintended and often undesired consequences on cost and other policy criteria of interest. While there has been anecdotal evidence of such system-wide interdependencies, this study affirms that such possibilities must be taken seriously. Rational nursing home regulation cannot proceed apart from a comprehensive understanding of the nursing home behavioral environment.

Injury Prevalence Among Children and Adolescents With Mental Retardation

Childhood injuries lead to increased morbidity and result in significant costs to public insurance programs. People with mental retardation, most of whom are covered by Medicaid, are at high risk for injury, which has implications for community inclusion, a central policy goal. Medicaid data from inpatient, outpatient, and long-term care settings represent an important new resource for injury surveillance in this population. Injury prevalence for 8.4 million Medicaid-eligible children in 26 states was measured using 1999 eligibility and claims data; 36.9% Medicaid beneficiaries ages 1 to 20 with mental retardation had at least one injury claim as compared with 23.5% of those without mental retardation. Prevalence rates are reported by gender and age for a variety of injury types.

Should Medicare Compensate Hospitals for Administratively Necessary Days

Days that a patient remains in a hospital due to inability to secure nursing home placement are termed administratively necessary days (ANDs). Some hospitals under Medicares prospective payment system have incurred discharge delays of this kind. Nursing home bed supply is one major problematic factor; others include adequacy of Medicare nursing home reimbursement rates relative to nursing home costs in an area, the willingness of facilities in an area to serve those needing skilled care, and stringency of relevant Medicaid reimbursement policy. Two promising approaches for dealing with ANDs are increasing nursing home reimbursement rates, and adjusting Medicare payments for exceptionally long-staying patients or those requiring exceptionally intensive care in hospitals.

National Health Expenditure Limits: The Case for a Global Budget Process

The health reform cost-containment debate has set up a dichotomy between market and regulatory approaches. Expenditures are excessive in the American health system because there is no effective constraint on aggregate demand, and the rigid limits imposed by sectoral global budgets in other nations do not effectively use supply side forces to achieve efficiency. The case for an intermediate option is presented, a process that can flexibly encompass both what buyers are willing to pay and what suppliers are willing to accept. A negotiated contracting process for multiple payors and multiple providers could constrain aggregate demand and harness provider incentives.

High-performance workplace practices in nursing homes: an economic perspective.

To develop implications for research, practice and policy, selected economics and human resources management research literature was reviewed to compare and contrast nursing home culture change work practices with high-performance human resource management systems in other industries. The organization of nursing home work under culture change has much in common with high-performance work systems, which are characterized by increased autonomy for front-line workers, self-managed teams, flattened supervisory hierarchy, and the aspiration that workers use specific knowledge gained on the job to enhance quality and customization. However, successful high-performance work systems also entail intensive recruitment, screening, and on-going training of workers, and compensation that supports selective hiring and worker commitment; these features are not usual in the nursing home sector. Thus despite many parallels with high-performance work systems, culture change work systems are missing essential elements: those that require higher compensation. If purchasers, including public payers, were willing to pay for customized, resident-centered care, productivity gains could be shared with workers, and the nursing home sector could move from a low-road to a high-road employment system.

Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey

Purpose To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies. Design and Methods Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics. Results Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job. Implications This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them.

Choosing a Nursing Home: What Do Consumers Want to Know, and Do Preferences Vary across Race/Ethnicity?

OBJECTIVE To identify what consumers want to know about nursing homes (NHs) before choosing one and to determine whether information preferences vary across race/ethnicity. DATA SOURCES/STUDY SETTING Primary data were collected in Greater Boston (January 2013-February 2014) from community-dwelling, white, black, and Latino adults aged 65+ and 40-64 years, who had personal/familial experience with a NH admission or concerns about one. STUDY DESIGN Eleven focus groups and 30 interviews were conducted separately by race/ethnicity and age group. PRINCIPAL FINDINGS Participants wanted detailed information on the facility, policies, staff, and residents, such as location, staff treatment of residents, and resident conditions. They wanted a sense of the NH gestalt and were interested in feedback/reviews from residents/families. Black and Latino participants were especially interested in resident and staff racial/ethnic concordance and facility cultural sensitivity. Latino participants wanted information on staff and resident language concordance. CONCLUSIONS Consumers want more information about NHs than what is currently available from resources like Nursing Home Compare. Report card makers can use these results to enhance their websites, and they should consider the distinct needs of different racial/ethnic groups. Future research should test methods for collecting and reporting resident and family feedback/reviews.