Category Archives: Nursing Homes & Long Term Care

Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes

Source: Adam Dean, Atheendar Venkataramani, and Simeon Kimmel, Health Affairs, Ahead of Print, September 10, 2020
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From the abstract:
More than 40% of all reported coronavirus disease 2019 (COVID-19) deaths in the United States have occurred in nursing homes. As a result, health care worker access to personal protective equipment (PPE) and infection control policies in nursing homes have received increased attention. However, it is not known if the presence of health care worker unions in nursing homes is associated with COVID-19 mortality rates. Therefore, we used cross-sectional regression analysis to examine the association between the presence of health care worker unions and COVID-19 mortality rates in 355 nursing homes in New York State. Health care worker unions were associated with a 1.29 percentage point mortality reduction, which represents a 30% relative decrease in the COVID-19 mortality rate compared to facilities without health care worker unions. Unions were also associated with greater access to PPE, one mechanism that may link unions to lower COVID-19 mortality rates. [Editor’s Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.]

Facility-level Factors Associated with CNA Turnover and Retention: Lessons for the Long-Term Services Industry

Source: Katherine A Kennedy, Robert Applebaum, John R Bowblis, The Gerontologist, Published: July 29, 2020
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From the abstract:
Background and Objectives:
Certified nursing assistant (CNA) turnover and retention are critical aspects of facilities’ ability to provide cost-effective, high quality person-centered care. Previous studies and industry practice often treat turnover and retention as similar concepts, assuming that low turnover and high retention are synonymous. The study addressed the question of whether turnover and retention rates differ and if so, what do those differences mean for nursing home practice, policy, and research.

Research Design and Methods:
This study examines facility-level factors associated with CNA retention and turnover rates using 2015 data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, Certification and Survey Provider Enhanced Report, and the Area Health Resource File. Using bivariate tests and regression analysis, we compare rates and the factors associated with retention and turnover.

Results:
The mean facility annual retention rate was 64% and the mean annual turnover rate was 55%. As expected, there was a statistically significant and negative correlation between the rates (r = -0.26). However, some facilities had both high retention and high turnover and some had low rates for both measures. Not all the variables that are associated with turnover are also associated with retention.

Discussion and Implications:
CNA retention is not simply the absence of CNA turnover. Given the differences, nursing homes may need to use strategies and policies designed to target a particular stability measure.

Nurse Aide Retention in Nursing Homes

Source: Nicholas G Castle, PhD, Kathryn Hyer, PhD, MPP, John A Harris, MD, MSc, John Engberg, PhD, The Gerontologist, Advance Access, March 6, 2020
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From the abstract:
Background and Objectives: The association of nurse aide retention with three quality indicators is examined. Retention is defined as the proportion of staff continuously employed in the same facility for a defined period of time.

Research Design and Methods: Data used in this investigation came from survey responses from 3,550 nursing facilities, Certification and Survey Provider Enhanced Reporting data, and the Area Resource File. Staffing characteristics, quality indicators, facility, and market information from these data sources were all measured in 2016. Nurse aide retention was measured at 1, 2, and 3 years of employment. The quality indicators examined were a count of all deficiency citations, quality of care deficiency citations, and J, K, L deficiency citations. Negative binomial regression analyses were used to study the associations between the three different retention measures and these three quality indicators.

Results: The 1-, 2-, and 3-year nurse aide retention measures were 53.2%, 41.4%, and 36.1%, respectively. The regression analyses show low levels of retention to be generally associated with poor performance on the three deficiency citation quality indicators examined.

Discussion and Implications: The research presented starts to provide information on nurse aide retention as an important workforce challenge and its potential impact on quality. Retention may be an additional staffing characteristic of nursing facilities with substantial policy and practice relevance.

Service Professionals’ Response to Volunteer Involvement in Service Production

Source: Mette Kjærgaard Thomsen, Ulrich Thy Jensen, Journal of Public Administration Research and Theory, Advance Access, Published: October 15, 2019
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From the abstract:
Involving volunteers in the production and delivery of public services is a core policy objective of governments around the world. While existing research on volunteer involvement in service production, for example, has focused on advantages and disadvantages of such involvement and different dimensions of volunteer involvement, little is known about service professionals’ response to volunteer involvement in public service production. Integrating perspectives from multiple theories, we build a theoretical framework for understanding how and when service professionals come to see volunteers as a threat to the quality of service, the profession’s privileged position and monopoly, and professionals’ own work tasks and job security. Based on a central distinction between production of core and complementary tasks, we propose that volunteers come to be seen as a threat in the eyes of service professionals when volunteers solve core rather than complementary tasks. Using a survey experiment among health assistants at nursing homes, we find partial support for our argument. Health assistants are more likely to perceive volunteers as a threat to the quality of care when volunteers solve core rather than complementary tasks. The study guides research toward a more nuanced understanding of volunteer involvement in service production in public organizations.

Citizen Participation and Its Impact on Performance in U.S. Nursing Homes

Source: Anna A. Amirkhanyan, Ohbet Cheon, Jourdan A. Davis, Kenneth J. Meier, Fei Wang, The American Review of Public Administration, Volume 49 Issue 7, October 2019
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From the abstract:
Fundamental to democratic societies, citizen participation is an important tool for promoting active, informed, and empowered citizenry as well as responsive and accountable administration. Past literature on citizen participation has focused on its determinants, forms, and prevalence. This study examines the relationship between a specific form of citizen participation—client participation—and organizational performance. We use hybrid data on U.S. nursing homes that combine a survey of nursing home administrators’ managerial practices with federal performance appraisal data. Our empirical findings suggest that more intense levels of client participation, such as the use of clients’ feedback in decision-making, are positively associated with performance: They increase the overall five-star ratings and lower health deficiencies. In contrast, less intense client participation efforts, such as merely communicating with client/family groups, are not significantly related to performance. This study highlights the role of participation intensity, suggesting that public administrators should not only go beyond informing and listening to their stakeholders, but also take steps to use the obtained feedback in organizational decision-making.

U.S. Nursing Assistants Employed in Nursing Homes: Key Facts (2019)

Source: PHI, September 3, 2019

From the abstract:
This research brief provides the latest annual snapshot of U.S. nursing assistants employed in nursing homes, including key demographics and a variety of wage and employment trends. This year’s research found that 581,000 nursing assistants support older people and people with disabilities in nursing homes. Nursing assistants are injured more than three times more frequently than the typical American worker, and earn a median hourly wage of $13.38 and a median annual income of $22,200.

Key Takeaways:
– The number of nursing assistants employed in nursing homes in the U.S. declined from just over 599,000 in 2008 to 581,000 in 2018.
– Nursing assistants earn a median hourly wage of $13.38 and a median annual income of $22,200.
– Nursing homes will need to fill nearly 680,000 nursing assistant job openings between 2016 and 2026.

Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations

Source: Fangli Geng, David G. Stevenson, and David C. Grabowski, Health Affairs, Vol. 38 No. 7, July 2019
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From the abstract:
Staffing is an important quality measure that is included on the federal Nursing Home Compare website. New payroll-based data reveal large daily staffing fluctuations, low weekend staffing, and daily staffing levels often below the expectations of the Centers for Medicare and Medicaid Services (CMS). These data provide a more accurate and complete staffing picture for CMS and consumers.

Evading the Catastrophic Costs of Nursing Home Care: A Theoretical Inquiry

Source: Gideon Yaniv, Public Finance Review, Volume: 47 issue: 4, July 2019
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From the abstract:
While many countries operate publicly funded programs to help care-needing elderly people finance the catastrophic costs of nursing home care, eligibility to public assistance may be means tested. To qualify for a means-tested program, applicants must first exhaust (spend down) their financial assets on privately paying for nursing home care, thereby wiping out their lifetime savings and children’s inheritance. They may naturally consider the possibility of hiding assets from the health agency, consequently shifting the financial burden to taxpayers. The present article adjusts two classical tax evasion models to capture the decision to evade the costs of nursing home care, focusing on the implications on the evaded costs and the program’s deficit of attempting to cope with the escalating costs of nursing home care by imposing a cost-sharing premium on the applicants’ adult children. Some insights on the socially optimal level of the cost-sharing premium are finally discussed.

Improving Job Quality for Direct Care Workers

Source: Paul Osterman, Economic Development Quarterly, Volume 33 Issue 2, May 2019
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From the abstract:
The prevalence of low wage work is a major challenge for American labor markets and health care is an industry in which many of these low wage workers are found. This paper provides data documenting these facts and then discusses strategies for upgrading job quality for long-term care workers who constitute the majority of low wage employees in health care occupations. In addition the paper briefly discusses approaches for upgrading the employment opportunities of low wage employees who are in the health industry but in jobs that are not health care specific.

Neglect Unchecked

Source: Kaiser Health News, 2018-2019

This Kaiser Health News series examines the reasons that long-term care facilities, their owners and the government fail to protect residents.

Though nursing homes are among the most heavily regulated types of medical providers, they remain dangerous places for frail residents. Four of 10 were cited for harming a patient or putting them in jeopardy over a three-year period.

Assisted living facilities have notably less oversight than nursing homes, even though they increasingly care for elderly people who are so frail that they might otherwise be in a nursing home.

This Kaiser Health News series examines the reasons that nursing homes, their owners and the government fail to protect residents.

Articles include:
Nursing Home Fines Drop As Trump Administration Heeds Industry Complaints
By Jordan Rau, Kaiser Health News, March 15, 2019
Inspectors are citing nursing facilities for violating health and safety more often than during the Obama administration. But the average fine is nearly a third lower than it was before President Donald Trump took office.

Assisted Living’s Breakneck Growth Leaves Safety Of Dementia Patients Behind
By Jordan Rau, Kaiser Health News, December 17, 2018
An analysis of inspection records in California, Florida and Texas shows significant numbers of violations related to assisted living residents with dementia.

1,400 Nursing Homes Get Lower Medicare Ratings Because Of Staffing Concerns
By Jordan Rau and Elizabeth Lucas, Kaiser Health News, July 30, 2018
Medicare said those homes either lacked a registered nurse for “a high number of days” over three months, provided data the government couldn’t verify or didn’t supply their payroll data at all.

‘Like A Ghost Town’: Erratic Nursing Home Staffing Revealed Through New Records
By Jordan Rau, Kaiser Health News, July 13, 2018
Daily nursing home payroll records just released by the federal government show the number of nurses and aides dips far below average on some days and consistently plummets on weekends.