Abstract
Objective
In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the
nursing home (NH) quality assurance system. This study examines trends in facility,
resident, and quality characteristics since passage of that legislation.
Methods
We conducted univariate analyses of national data on US NHs from 3 sources: (1) the
1985 National Nursing Home Survey (NNHS), (2) the 1992-2015 Online Survey Certification
and Reporting (OSCAR) Data, and (3) LTCfocUS data for 2000-2015. We examined changes
in NH characteristics, resident composition, and quality.
Setting and participants
US NH facilities and residents between 1985 and 2015.
Results
The proportion of NHs that are Medicare and Medicaid certified, members of chains,
and operating not-for-profit has increased over the past 30 years. There have also
been reductions in occupancy and increases in the share of residents who are racial
or ethnic minorities, admitted for post-acute care, in need of physical assistance
with daily activities, primarily supported by Medicare, and diagnosed with a psychiatric
condition such as schizophrenia. With regard to NH quality, direct care staffing levels
have increased. The proportion of residents physically restrained has decreased dramatically,
coupled with changes in inappropriate antipsychotic (chemical restraint) use.
Conclusions and implications
Together with changes in the long-term care market, the NHs of today look very different
from NHs 30 years ago. The 30th anniversary of OBRA provides a unique opportunity
to reflect, consider what we have learned, and think about the future of this and
other sectors of long-term care.
Keywords
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References
- Nursing home care quality twenty years after the Omnibus Budget Reconciliation Act of 1987.(Available at:)https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7717.pdfDate: 2007Date accessed: November 30, 2018
- Improving the Quality of Care in Nursing Homes.National Academy Press, Washington, DC1986
- The hidden costs of rebalancing long-term care health services research.Health Serv Res. 2014; 49: 771-777
- Supporting home- and community-based care: Views of long-term care specialists.Med Care Res Rev. 2010; 67: 82-101
- Home and community-based services: Public policies to improve access, costs, and quality.(Available at:)http://nasuad.org/sites/nasuad/files/hcbs/files/153/7617/PASCenter_HCBS_policy_brief.pdfDate: 2009Date accessed: November 14, 2016
- Medicaid expenditures for long-term services and supports (LTSS) in FY 2013: Home and community-based services were a majority of LTSS spending. 2015.(Available at:)https://www.medicaid.gov/medicaid/ltss/downloads/ltss-expenditures-fy2013.pdfDate: 2015Date accessed: October 3, 2018
- United States Department of Health and Human Services. National Center for Health Statistics. National Nursing Home Survey.Inter-university Consortium for Political and Social Research [distributor], 2006-01-12, Ann Arbor, MI1985
- Physician and nurse staffing in nursing homes: The role and limitations of the Online Survey Certification and Reporting (OSCAR) system.J Am Med Dir Assoc. 2005; 6: 27-33
- The residential history file: Studying nursing home residents’ long-term care histories.Health Serv Res. 2011; 46: 120-137
- The quality of care. How can it be assessed?.JAMA. 1988; 260: 1743-1748
- Facts about federal deemed status and state recognition | Joint Commission.(Available at:)https://www.jointcommission.org/facts_about_federal_deemed_status_and_state_recognition/Date: 2017Date accessed: November 30, 2018
- Nursing Home Divestiture and Corporate Restructuring: Final Report.US Department of Health and Human Services, Washington, DC2006: 3
- Ownership conversions and nursing home performance.Health Serv Res. 2008; 43: 1184-1203
- Where are the missing elders? The decline in nursing home use, 1985 and 1995.Health Aff. 1999; 18: 146-155
- Growth of racial and ethnic minorities in US nursing homes driven by demographics and possible disparities in options.Health Aff. 2011; 30: 1358-1365
- Sizing up the market for assisted living 2010.Health Aff (Millwood). 2010; 29: 35-43
- Increasing prevalence of assisted living as a substitute for private-pay long-term nursing care.Health Serv Res. 2018; 53: 4906-4920
- Residential Care Communities and Their Residents in 2010: A National Portrait.(DHHS Publ. No.: 2016-1041) National Center forHealth Statistics, Hyattsville, Md2016: 13-21
- Local Medicaid home- and community-based services spending and nursing home admissions of younger adults.Am J Public Health. 2014; 104: e15-e17
- The relationship between Older Americans Act Title III state expenditures and prevalence of low-care nursing home residents.Health Serv Res. 2013; 48: 1215-1226
- Providing more home-delivered meals is one way to keep older adults with low care needs out of nursing homes.Health Aff. 2013; 32: 1796-1802
- The relationship between Older Americans Act in-home services and low-care residents in nursing homes.J Aging Health. 2014; 26: 250-260
- Predictors of low-care prevalence in Florida nursing homes: The role of Medicaid waiver programs.Gerontologist. 2011; 51: 495-503
- Medicare prospective payment and the volume and intensity of skilled nursing facility services.J Health Econ. 2011; 30: 675-684
- The effect of state Medicaid case-mix payment on nursing home resident acuity.Health Serv Res. 2006; 41: 1317-1336
- “Quicker and sicker” under Medicare’s prospective payment system for hospitals: New evidence on an old issue from a national longitudinal survey.Bull Econ Res. 2011; 63: 1-27
- Improving hospital discharge planning for elderly patients.Health Care Financ Rev. 1997; 19: 47-72
- The staffing-outcomes relationship in nursing homes.Health Serv Res. 2008; 43: 1025-1042
- The influence of nurse staffing levels on quality of care in nursing homes.Gerontologist. 2011; 51: 610-616
- Do Medicaid incentive payments boost quality? Florida’s Direct Care Staffing Adjustment Program.J Aging Soc Policy. 2013; 25: 65-82
- Public reporting drove quality gains at nursing homes.Health Aff. 2010; 29: 1706-1713
- Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987.Med Care Res Rev. 1998; 55: 139-170
- The factors that influence nurses’ use of physical restraint: A thematic literature review.Int J Nurs Pract. 2011; 17: 195-204
- Nursing home deficiency citations for physical restraints and restrictive side rails.West J Nurs Res. 2013; 35: 546-565
- Mental health outcomes and physical restraint use in nursing homes.Adm Policy Ment Health. 2006; 33: 696-704
- Characteristics of nursing home residents and physical restraint: A systematic literature review.J Clin Nurs. 2014; 23: 3012-3024
- Antipsychotic use and the risk of hip fracture among older adults afflicted with dementia.J Am Med Dir Assoc. 2010; 11: 120-127
- Antipsychotic drug use and mortality in older adults with dementia.Ann Intern Med. 2007; 146: 775-786
- Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014.JAMA Intern Med. 2018; 178: 640
- Impact of FDA Black Box Advisory on antipsychotic medication use.Arch Intern Med. 2010; 170: 96-103
- CMS strategies to reduce antipsychotic drug use in nursing home patients with dementia show some progress.Health Aff. 2017; 36: 1299-1308
- Prevalence and predictors of anticholinergic medication use in elderly nursing home residents with dementia.Drugs Aging. 2010; 27: 987-997
- Special care units and traditional care in dementia: Relationship with behavior, cognition, functional status and quality of life—A review.Dement Geriatr Cogn Dis Extra. 2013; 3: 360-375
- Serious mental illness and nursing home quality of care.Health Serv Res. 2013; 48: 1279
- Quality of mental health care for nursing home residents: A literature review.Med Care Res Rev. 2010; 67: 627-656
- Predictors of successful prompted voiding among incontinent nursing home residents.JAMA. 1995; 273: 1366-1370
- Predicting nursing-home resident responsiveness to a urinary incontinence treatment protocol.Int Urogynecol J. 1993; 4: 89-94
- Urinary and fecal incontinence in nursing home residents.Gastroenterol Clin North Am. 2008; 37 (x): 697-707
- Defining and measuring nursing home placement.J Am Geriatr Soc. 2018; 66: 1866-1868
Article info
Publication history
Published online: August 23, 2019
Footnotes
This work was supported by the National Institute on Aging (P01 AG027296); the Agency for Healthcare Research and Quality (4T32 HS000011); and the Veterans Affairs Health Services Research and Development Service (CDA 14-422).
VM is chair, Independent Quality Committee, of HCR Manor Care; is chair, Scientific Advisory Board, and consultant for NaviHealth, Inc; and former director, PointRight, Inc (holds less than 1% equity). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the National Institutes of Health, or the United States government.
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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