Abstract
From 2000 through 2013, there have been 1,223 nursing home closures. Nursing home closures have been shown to have a negative impact on the displaced resident’s health. Displaced nursing home residents often face significant detrimental health effects, such as, a decrease in social engagement and with activities of daily living. Nursing homes that typically close do so because of financial difficulties.
This paper will examine the quality of care delivered in nursing homes under financial distress. This study will use 2000–2013 data from the Medicare Cost Reports, the Online Survey Certification of Automated Records (OSCAR), Certification and Survey Provider Enhanced Reports (CASPER), Long-Term Care (LTC) Focus, and the Area Resource File. The sample size will be approximately 15,600 facilities per year. The dependent variables consist of quality variables that include RN, LPN, and CNA staffing ratios, residents with catheters, restraints, pressure ulcers, bowel incontinence, bladder incontinence, hospitalizations, re-hospitalizations, and facility quality of care deficiencies. The independent variable will consist of a dichotomous variable identifying where a nursing home is in financial distress as calculated by the validated Altman Z-score. Control variables include for-profit status, size, acuity index, and market competition (Herfindahl Index). Data are analyzed using fixed effects regression and lagged independent variables.
If financial distress is correlated with inferior resident quality care, this should illuminate some reasons for disparities in the delivery of care of long-term care. Understanding how organizational performance is correlated with resident care quality has the potential to provide insights on how to address and improve patient care delivery.