Explaining Differences in Remuneration Rates of Nursing Homes in Germany

Remuneration rates of German nursing homes are prospectively negotiated between long-term care insurance (LTCI) and social assistance on the one side and nursing homes on the other. They diff er considerably across regions while there is no evidence for substantial differences in care provision. This paper explains the differences in the remuneration rates by observable characteristics of the nursing home, its residents and its region with a special focus on the largest federal state North-Rhine-Westphalia, in which the most expensive nursing homes are located. We use data from the German Federal Statistical Office for 2005 on all nursing homes that off er full-time residential care for the elderly. We find that differences in remuneration rates can partly be explained by exogenous factors. Controls for residents, nursing homes, and district characteristics explain roughly 30% of the price difference; 40% can be ascribed to a regionally different kind of negotiation between nursing homes and LTCI. 30% of the raw price difference remains unexplained by observable characteristics.Nursing homes; determinants of remuneration rates; regional price differences

Culture Change in Nursing Homes: How Far Have We Come?

Presents findings from the Commonwealth Fund 2007 National Survey of Nursing Homes on the extent to which nursing homes have adopted the principles of culture change and are delivering resident-centered care, as well as the benefits the changes have brou

Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.

Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation

The Mediating Role of Staffing on Quality of Care in Nonprofit and For-Profit Nursing Homes in Indiana

This study attempts to disentangle the relationships between ownership, staffing, and nursing home quality using Indiana nursing home data. Typical Indiana nursing homes are known to be below average on health inspection and overall quality ratings. This is alarming because Indiana’s population aged 85 years or older is increasing and these individuals are likely to need long-term care services. With an ultimate goal of addressing the poor quality of long-term care institutions, this study analyzed the Nursing Home Compare data collected from 2010 to 2012 by utilizing chi- square tests, one-way ANOVAs, and correlation analysis. The results revealed that nonprofit nursing homes have superior quality and record a greater number of registered nurse and certified nursing assistant hours per resident day compared to for-profit nursing homes. In addition, higher staffing hours were positively associated with overall rating. These findings imply a possibility that higher staffing levels in nonprofit nursing homes have a mediating effect on the relationship between ownership and nursing home quality. In order to improve nursing home quality, registered nurse and certified nursing assistant staffing levels need to be boosted. Enactment of state staffing standards and the Medicaid wage pass-through policy could help to address this issue

Attitudes and Perceptions of Nursing Homes.

The purpose of this study was to examine how past experiences with nursing homes influence perceptions and attitudes of college students toward nursing homes in the United States. A review of the current research literature indicates that nursing homes are publicly scrutinized in a negative manner. Variables examined included students’ college of study, experience with nursing homes either from personal experience, from a well-known relative or friend, or the media, and different attitudes and perceptions including good or bad views of nursing homes. Results indicate that students’ perceive nursing homes more negatively than positively even when their experience came from personal knowledge. Students enrolled in health services do not perceive nursing homes more positively than negatively or any better than students enrolled in other courses of study. Moreover, there was no significant relationship between the students’ perceptions of nursing homes and their field of study

Monitoring sound levels and soundscape quality in the living rooms of nursing homes : a case study in Flanders (Belgium)

Recently there has been an increasing interest in the acoustic environment and its perceptual counterpart (i.e., the soundscape) of care facilities and their potential to affect the experience of residents with dementia. There is evidence that too loud sounds or poor soundscape quality more generally can affect negatively the quality of life of people with dementia and increase agitation. The AcustiCare project aims to use the soundscape approach to enhance the Quality of Life (QoL) of residents and to reduce Behavioral and Psychological Symptoms of Dementia (BPSD), as well as improving the everyday experience of nursing homes for both residents and staff members. In order to gain further insights into the sound environments of such facilities, sound level monitoring and soundscape data collection campaigns were conducted in the living rooms of five nursing homes in Flanders. Results showed that sound levels (dB) and loudness levels (sone) did not vary significantly between days of the week, but they did so between moments of the day and between living rooms. From the perceptual point of view, several soundscape attributes and the perceived prominence of different sound source types varied significantly between the living rooms investigated, and a positive correlation was found between sound levels and the number of persons present in the living rooms. These findings claim for further attention on the potential role of the sound domain in nursing homes, which should promote (and not only permit) better living and working conditions for residents and staff members of nursing homes

COVID-19 And Nursing Home Care In The US: Regional Differences Associated With Disparities In Race, Ethnicity And Community And Facility Characteristics

Purpose: To investigate U.S. nursing homes associated COVID-19 cases in relation to county-level and nursing home facility characteristics. Study Motivation: As of July 2020, there were approximately 1.3 million people residing in 15,483 nursing homes in the United States. Nursing homes account for approximately 40% of COVID-19 deaths in the United States, and many individuals residing in nursing homes have underlying respiratory conditions, making them especially susceptible to increased severity and harm from the virus. Infection control deficiencies are the most common deficiency nursing homes receive with almost 40% of the nation's nursing homes having at least one infection control deficiency in 2017. Media reports indicate that nursing homes that have more staff shortages, and experience more survey deficiencies have a larger number of staff and residents who are positive for COVID-19

Pain assessment strategies in home care and nursing homes in Mid-Norway: a cross-sectional survey

-The prevalence of pain ranges from 27.8% to 86.5% in nursing homes and 42% to 50% in home care. Pain assessment is the first step toward effective pain management. The aim of this study was to explore the use of pain assessment strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. The study was a descriptive cross-sectional survey. Health care providers who were responsible for the patients' medications replied to a questionnaire. In-home care and nursing homes in 11 randomly selected municipalities in Mid-Norway were included. Three hundred ninety-two individuals were included in this study (70% response rate): 271 (69%) from nursing homes and 121 (31%) from home care. The respondents working in home care had a higher educational level than those in working in nursing homes. Pain assessment instruments were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients' total pain experience than did those in nursing homes. Workplace (working in home care) and regular training in the use of pain assessment tools explained more than 20% of the variation in the use of pain assessment tools. Regular training in the use of pain assessment tools is needed for health care workers in home care and nursing homes

Subsidies, Quality, and Regulation in the Nursing Home Industry

This paper analyzes the impact of the Medicaid patient subsidy and Certificate of Need (CON) cost containment programs on nursing home behavior.The analysis is complicated by the fact the both proprietary and "not for profit" nursing homes exist, and by the problem that qualityis not directly observed. Medicaid pays the for the care of the financially indigent by directly reimbursing nursing homes at a predetermined rate. As a result, nursing homes can price discriminate between patients who finance their care privately and patients whose care is financed by Medicaid. Nevertheless, nursing homes are required to provide the same quality to both types of patients. Typically, Medicaid reimbursement rates are set by a cost plus method, where the reimbursement per patient is equal to average cost plus some return referred to as the Medicaid "plus" factor. Our results show that Medicaid policymakers face a trade-off between quality and the access of poor to nursing home care. Specifically, we find that increases in the Medicaid "plus" factor cause nursing homes to reduce quality and substitute Medicaid patients for "private pay" patients. These quality differences can be quite large. In fact, in our sample, we find that homes who receive high Medicaid "plus" factors provide hundreds of thousands of dollars less in goods and services than homes who receive average Medicaid "plus" factors, certris paribus. CON attempts to control nursing home expenditures by limiting the supply of beds with capacity constraints and entry barriers. Our analysis shows that CON policy makers are forced to trade off containing the size of the industry (and therefore total Medicaid payments) against quality and access of the poor to nursing home care. Specifically, we find that the capacity constraints and the reduced competition from the entry barriers lead to lower quality and fewer Medicaid patients receiving care.

‘I feel like a salesperson’: the effect of multiple-source care funding on the experiences and views of nursing home nurses in England

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses' reluctance to work in these settings are determined. This paper considers the influence that multiple-source care funding issues have on nursing home nurses' experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with 'selling beds'; and coping with self-funding residents' changing expectations of care. The findings of the study suggest that multiple-source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention