Table 3:

Facility Level Characteristics and Performance on Culture Change Indices, Ordered Logit Models


	Physical Environment¹	Resident Centered Care¹	Staff Empowerment¹	Family and Community¹
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)

Nursing Home Structure and Staffing
For Profit	0.640^***	0.950	0.997	0.990
	(0.493 – 0.830)	(0.737 – 1.223)	(0.759 – 1.310)	(0.805 – 1.217)

Bed Count
<80	Ref	Ref	Ref	Ref
80–120	1.117	1.227	1.060	0.951
	(0.851 – 1.468)	(0.902 – 1.669)	(0.795 – 1.414)	(0.750 – 1.206)
>120	1.328^***	1.195	0.964	0.945
	(1.074 – 1.643)	(0.866 – 1.648)	(0.709 – 1.310)	(0.699 – 1.277)

Occupancy Rate (5 Point Increase)	1.061^***	1.044^*	1.007	1.020
Occupancy Rate (5 Point Increase)	(1.021 – 1.104)	(0.999 – 1.090)	(0.971 – 1.045)	(0.977 – 1.065)

Part of a Chain	0.986	1.054	0.819^**	0.801^*
	(0.752 – 1.292)	(0.835 – 1.329)	(0.681 – 0.984)	(0.642 – 1.000)

Religious Affiliation	1.321	0.858	1.023	0.762
	(0.747 – 2.336)	(0.556 – 1.325)	(0.519 – 2.015)	(0.429 – 1.354)

Continuing Care	1.987^***	1.182	0.926	0.978
Retirement Community²	(1.596 – 2.474)	(0.840 – 1.665)	(0.662 – 1.294)	(0.757 – 1.263)

Any Special Unit	0.892	1.172	0.885	0.816

(Except Ventilator Unit)	(0.681 – 1.168)	(0.866 – 1.586)	(0.683 – 1.146)	(0.604 – 1.103)
Directors of Nursing in Past Two Years
One	Ref	Ref	Ref	Ref
Two or More	0.753^**	0.741^**	0.976	0.909
	(0.605 – 0.937)	(0.561 – 0.978)	(0.719 – 1.324)	(0.728 – 1.133)

Administrators in Past Two Years
One	Ref	Ref	Ref	Ref
Two or More	1.021	0.986	0.851	1.096
	(0.777 – 1.340)	(0.746 – 1.304)	(0.694 – 1.044)	(0.849 – 1.415)

RN³ Hours / Resident	1.089	1.042	0.876^**	0.894^**
Day (Standardized)	(0.976 – 1.216)	(0.926 – 1.173)	(0.781 – 0.984)	(0.802 – 0.997)

LPN³ Hours/Resident Day (Standardized)	1.124^*	0.990	0.938	1.011
LPN³ Hours/Resident Day (Standardized)	(0.995 – 1.270)	(0.855 – 1.146)	(0.824 – 1.068)	(0.911 – 1.121)

CNA² Hours/Resident Day (Standardized)	1.060	1.132	1.157^*	1.066
CNA² Hours/Resident Day (Standardized)	(0.951 – 1.181)	(0.973 – 1.316)	(0.983 – 1.363)	(0.941 – 1.207)

Leadership Score	1.693^***	1.834^***	3.650^***	2.684^***
(3 Point Increase)	(1.525 – 1.880)	(1.676 – 2.007)	(3.328 – 4.003)	(2.405 – 2.995)

State Policy and Regional Characteristics

State Pay for Performance (2014)
No	Ref	Ref	Ref	Ref
Yes: No CC³ Measures	0.780	0.827^*	0.994	1.605^***
	(0.570 – 1.068)	(0.670 – 1.020)	(0.795 – 1.243)	(1.251 – 2.058)
Yes: With CC³ Measures	1.817^***	1.718^***	1.761^***	1.206
	(1.307 – 2.528)	(1.246 – 2.369)	(1.369 – 2.266)	(0.789 – 1.843)

Medicaid Rate	1.009^***	0.997	1.002	1.000
($10 increase)	(1.002 – 1.016)	(0.993 – 1.002)	(0.997 – 1.006)	(0.996 – 1.005)

County Hirschman-Herfindahl Index
First Quartile	Ref	Ref	Ref	Ref
Second Quartile	0.891	0.829	0.875	0.558^***
	(0.640 – 1.241)	(0.595 – 1.157)	(0.636 – 1.205)	(0.412 – 0.755)
Third Quartile	1.079	1.067	0.895	0.635^*
	(0.713 – 1.633)	(0.743 – 1.531)	(0.627 – 1.277)	(0.401 – 1.006)
Fourth Quartile	1.006	0.719	1.096	0.612^*
	(0.648 – 1.560)	(0.445 – 1.163)	(0.743 – 1.617)	(0.363 – 1.033)

Metropolitan County	1.149	1.223	0.991	0.850
	(0.870 – 1.517)	(0.864 – 1.733)	(0.686 – 1.431)	(0.616 – 1.174)

Census Sub-Region
West North Central	Ref	Ref	Ref	Ref
West South Central	0.701^*	0.885	0.986	0.927
	(0.488 – 1.007)	(0.451 – 1.739)	(0.671 – 1.448)	(0.531 – 1.617)
East North Central	0.520^***	1.100	0.790^*	1.156
	(0.342 – 0.792)	(0.786 – 1.539)	(0.603 – 1.035)	(0.761 – 1.758)
East South Central	0.225^***	0.925	1.253	1.991^**
	(0.144 – 0.352)	(0.350 – 2.445)	(0.822 – 1.910)	(1.149 – 3.450)
Middle Atlantic	0.250^***	0.704^*	0.824	0.882
	(0.140 – 0.446)	(0.469 – 1.056)	(0.496 – 1.367)	(0.542 – 1.435)
Mountain	0.392^***	0.909	0.748	2.060^*
	(0.203 – 0.758)	(0.524 – 1.577)	(0.492 – 1.138)	(0.995 – 4.267)
New England	0.277^***	0.522^***	1.135	0.597^**
	(0.141 – 0.542)	(0.338 – 0.807)	(0.658 – 1.957)	(0.359 – 0.992)
Pacific	0.0998^***	0.771	1.227	1.052
	(0.0372 – 0.268)	(0.539 – 1.103)	(0.698 – 2.159)	(0.605 – 1.826)
South Atlantic	0.255^***	1.081	1.084	1.377
	(0.129 – 0.503)	(0.740 – 1.581)	(0.645 – 1.821)	(0.874 – 2.170)

Resident Case Mix

Percent Black Residents
Lowest Decile	Ref	Ref	Ref	Ref
Below Median	0.581^***	0.932	1.038	0.995
	(0.397 – 0.852)	(0.632 – 1.374)	(0.678 – 1.591)	(0.711 – 1.392)
Above Median	0.576^***	0.755^*	0.880	1.056
	(0.431 – 0.771)	(0.569 – 1.002)	(0.578 – 1.338)	(0.797 – 1.400)
Top Decile	0.383^***	0.767	0.997	0.936
	(0.238 – 0.619)	(0.504 – 1.167)	(0.551 – 1.804)	(0.600 – 1.463)

Percent Hispanic Residents
Below Median	Ref	Ref	Ref	Ref
Above Median	0.986	1.082	1.007	0.861
	(0.790 – 1.231)	(0.833 – 1.405)	(0.801 – 1.267)	(0.669 – 1.107)
Top Decile	0.711^*	1.274	0.649^*	0.624^**
	(0.488 – 1.037)	(0.895 – 1.815)	(0.418 – 1.007)	(0.420 – 0.927)

Percent with Medicare
Lowest Decile	Ref	Ref	Ref	Ref
Below Median	0.989	1.784^**	1.233	1.317^*
	(0.742 – 1.320)	(1.144 – 2.784)	(0.803 – 1.893)	(0.963 – 1.802)
Above Median	1.107	1.382	1.062	0.938
	(0.756 – 1.621)	(0.884 – 2.163)	(0.642 – 1.759)	(0.637 – 1.379)
Top Decile	1.676^**	1.752	1.239	1.054
	(1.038 – 2.707)	(0.872 – 3.520)	(0.666 – 2.306)	(0.652 – 1.702)

Percent with Medicaid
Lowest Decile	Ref	Ref	Ref	Ref
Below Median	0.989	1.784^**	1.233	1.317^*
	(0.742 – 1.320)	(1.144 – 2.784)	(0.803 – 1.893)	(0.963 – 1.802)
Above Decile	1.107	1.382	1.062	0.938
	(0.756 – 1.621)	(0.884 – 2.163)	(0.642 – 1.759)	(0.637 – 1.379)
Top Decile	1.676^**	1.752	1.239	1.054
	(1.038 – 2.707)	(0.872 – 3.520)	(0.666 – 2.306)	(0.652 – 1.702)

Age (1 Year Increase)	1.019	1.022^**	1.009	1.011
	(0.990 – 1.049)	(1.002 – 1.042)	(0.986 – 1.032)	(0.986 – 1.038)

Average RUGS NCMI³	1.001	1.085	0.909	1.069
(Standardized)	(0.885 – 1.132)	(0.939 – 1.254)	(0.761 – 1.084)	(0.927 – 1.233)

Average ADL³ (Standardized)	0.899	1.022	1.089	0.984
Average ADL³ (Standardized)	(0.760 – 1.064)	(0.894 – 1.167)	(0.904 – 1.312)	(0.840 – 1.152)

Percent High CFS³	1.000	0.965	1.003	1.101^*
(10 Percent Increase)	(0.861 – 1.161)	(0.844 – 1.103)	(0.917 – 1.097)	(0.983 – 1.233)

^***

p<0.01,

^**

p<0.05,

p<0.1

^1.

Domain indices were included in the ordered logit model using quartiles of performance for the given index. NHs were divided into quartiles of performance based on the distribution of performance on the domain.

^2.

”Yes” response includes nursing homes that answered Yes to “Is your facility part of a Continuing Care Retirement Community?” as well as those that answered “No,” but indicated that they have long-term care beds, assisted living residences, and independent living residences.

^3.

RN = Registered Nurse, LPN = Licensed Practical Nurse, CNA = Certified Nursing Assistant, CC=Culture Change, RUGS NCMI =Resource Utilization Group - Average Nursing Case-Mix Index, ADL = Activities of Daily Living Score, CFS = Cognitive Function Score.