Abstract
Objectives
The Centers for Medicare & Medicaid Services Nursing Home Compare (NHC) serves as
the most comprehensive repository of Medicaid- and/or Medicare-certified nursing homes
providing services to approximately 1.4 million US residents. A gap in the literature
exists in understanding on the national level whether residents from socioeconomically
disadvantaged counties experience disparities in the access to nursing homes with
higher NHC star ratings. The study aimed to examine nursing home quality variations
with regard to county-level socioeconomic, geographic, and metropolitan status, while
adjusting for nursing home facility-level characteristics.
Design
Cross-sectional ecological study.
Setting and participants
15,090 Medicaid/Medicare-certified nursing homes with nonmissing star ratings.
Measures
Study outcomes were NHC overall, health inspection survey, nurse staffing, and quality
measure star ratings. County-level measures included SES index, geographic regions,
and metropolitan status. Facility-level characteristics included ownership, chain
affiliation, type and length of Medicaid/Medicare certification, hospital affiliation,
continuing care retirement community status, number of certified beds, and occupancy.
Results
Counties with average adjusted overall, nurse staffing, and quality measure star ratings
below 3 stars appeared to be clustered in the South. Nursing homes located in counties
with lower SES were associated with lower overall star ratings [adjusted mean stars:
3.66 to 3.84, 95% confidence interval (CI): (3.54, 3.79) to (3.73, 3.95)]. A similar
pattern was observed in staffing [adjusted mean stars: 3.75 to 4.23, 95% CI: (3.54,
3.97) to (4.10, 4.35)] and quality ratings [adjusted mean stars: 3.29 to 3.52, 95%
CI: (3.12, 3.47) to (3.35, 3.69)].
Conclusions
Residents in socioeconomically disadvantaged counties experience disparities in accessing
nursing homes with higher star ratings. These areas may lack sufficient resources
to adequately staff the facility and deliver care that meets industry quality standards.
These issues are likely to persist and possibly even worsen for the lower- and middle-class
geriatric population given the current uncertainty around healthcare reform.
Keywords
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Article info
Publication history
Published online: July 05, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
