Table 1.
Definition of Resident‐, Facility‐, and Market‐Level Variables
| Variable | Variable Construction | Data Source |
|---|---|---|
| Market‐level variables | ||
| Herfinadahl–Hirschman Index | Measure of county's nursing home concentration; ranges from 0 to 1 with 1 representing a monopoly over a market's nursing home beds | LTCFocUs |
| Market occupancy | Number of occupied nursing home beds divided by the total number of beds in the county | LTCFocUS |
| Median household income | Median household income for the county | AHRF |
| Population density | Number of people per square mile for the county based on 2010 census | AHRF |
| Proportion of residents 65 years and older | County's population aged 65 years or older divided by the total population of the county | AHRF |
| Facility‐level variables | ||
| Total deficiency score | A summary score that captures the scope and severity of all violations and reported deficiencies based on the CMS Star rating | OSCAR |
| For‐profit ownership |
0 = Nonprofit 1 = For‐profit |
OSCAR |
| Chain membership |
0 = Independent 1 = Member of a chain |
OSCAR |
| Occupancy | Total number of residents divide by total number of residential care beds | OSCAR |
| Number of beds | Total number of beds in the facility | OSCAR |
| FTE RN HPRD | Continuous; number of full‐time equivalent registered nurses hours per resident per day (HPRD) | OSCAR |
| FTE LPN HPRD | Continuous; number of full‐time equivalent licensed nurses hours per resident per day (HPRD) | OSCAR |
| FTE CNA HPRD | Continuous; number of full‐time equivalent certified nursing assisted hours per resident per day (HPRD) | OSCAR |
| Social workers per 100 residents | Continuous; number of full‐time equivalent social workers per 100 residents | OSCAR |
| Proportion of Medicaid residents | Number of Medicaid residents divided by the total number of residents | OSCAR |
| Proportion of Medicare residents | Number of Medicare residents divided by the total number of residents | OSCAR |
| Proportion of residents admitted from acute care | Proportion of all admissions to the facility in the calendar year that were from an acute care hospital | LTCFocUS |
| Average episode length | Facility‐level aggregate based on study cohort; average number of days for an episode of care | MDS |
| Resident‐level variables | ||
| Age at admission | Continuous; calculated from birth date and date of admission | MDS |
| Marital status |
0 = Not married (includes never married, widowed, separated, and divorced) 1 = Married |
MDS |
| Race/ethnicity |
0 = Hispanic; black, non‐Hispanic; other 1 = White, non‐Hispanic (reference) |
MDS |
| Gender |
0 = Male 1 = Female |
MDS |
| Depression |
0 = No signs of depression 1 = Major/nonmajor depression |
MDS |
| Cognitive performance scale |
Three dummy variables Cognitively intact: scores 0–1 (reference) Mild/moderate impairment: scores 2–4 Severe impairment: scores 5–6 |
MDS |
| Lived alone before entry |
0 = Lived in another facility prior to admission 1 = Lived alone prior to admission |
MDS |
| Behavioral problem(s) |
0 = No behavioral problems 1 = Exhibited at least one of the following within the last 7 days: wandering, resisting care, verbally abusive, physically abusive, or socially inappropriate/disruptive behavioral symptoms |
MDS |
| ADL impairment | Continuous; activities of daily living (ADL) self‐performance scale, range: 0–28 | MDS |
| Urinary incontinence | Displayed urinary incontinence at least twice per week (scores 2 and greater) | MDS |
| Fecal incontinence | Displayed fecal incontinence at least once per week (scores 2 and greater) | MDS |
| Recent fall |
0 = No fall 1 = Experienced a fall in the past 180 days |
MDS |
| Recent fracture |
0 = No fracture 1 = Experienced a fracture (hip or otherwise) in the past 180 days |
MDS |
| Mental health diagnosis |
0 = No mental health diagnosis 1 = Diagnosis of schizophrenia or bipolar disorder |
MDS |
| Diseases |
Dummy variable defined separately for each disease (cancer, congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD]/emphysema, diabetes, Parkinson's disease, renal failure, stroke/cerebrovascular accident) 0 = No disease 1 = Yes, disease present |
MDS |
Data sources were the Minimum Data Set (MDS), the federal Online Survey, Certification, and Reporting (OSCAR) databases, the LTCfocUS.org website, and the Area Health Resource File (AHRF).ADL, activities of daily living; CNA, certified nurse aid; FTE, full‐time equivalent; LPN, licensed practice nurse; NH, nursing home; RN, registered nurse.