Determinants of Nursing Home Regulatory Activity in the 50 States: An Analysis from the Political Ec...
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Determinants of Nursing Home Regulatory Activity in the 50 States: An Analysis from the Political Economy Perspective. Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards SAMSI Transition Workshop November 10, 2005. Acknowledgments.

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Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards SAMSI Transition Workshop

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Christopher m kelly phoebe s liebig and lloyd j edwards samsi transition workshop

Determinants of Nursing Home Regulatory Activity in the 50 States: An Analysis from the Political Economy Perspective

Christopher M. Kelly, Phoebe S. Liebig, and Lloyd J. Edwards

SAMSI Transition Workshop

November 10, 2005


Acknowledgments

Acknowledgments

  • Dr. Kelly was supported in part by a postdoctoral fellowship1 in the Carolina Program in Health and Aging Research (CPHAR) at the University of North Carolina at Chapel Hill

    1Grant ST32AG00272 from the National Institute on Aging


Nursing home regulation in the united states

Nursing Home Regulation in the United States

  • Under OBRA 87, states survey nursing homes, CMS oversees

  • State surveyors rate nursing home deficiencies according to scope and severity

  • Information is available to consumers on CMS’s Nursing Home Compare website


Research questions

Research Questions

  • What is the extent of nursing home regulatory activity in the 50 states?

  • How did extent change over a three-year period?

  • What factors predict citation volume & severity in the 50 states?


Political economy perspective

Political Economy Perspective

Age

Race

State

Citizen/Public

Sex/Gender Capital

Class

Ideology

Estes (2001)


Linear mixed model

Linear Mixed Model

  • Used to identify predictors of the volume and severity of state citations

  • Provides estimation and hypothesis testing for modeling population and random effects

  • Can accommodate data missing completely at random


Linear mixed model is useful for studying state regulatory activity

Linear Mixed Model is Useful for Studying State Regulatory Activity

  • Longitudinal data (i.e. nursing home quality over several years)

  • Population data - 50 U.S. states.

    Large sample techniques are challenged.

  • Parsimonious model needed (N =50)

  • Random intercept and slope.

  • Within-subject errors assumed i.i.d.


Nursing home deficiencies stable but less severe

Nursing Home Deficiencies Stable, but Less Severe

  • Number of deficiencies has remained level (about 6 per nursing home)

  • Percentage of severe deficiencies has declined (about 7% of all deficiencies cause actual harm)

  • States vary widely in volume & severity of deficiency citations


Possible predictors of the extent of state regulatory activity

External Determinants

Urbanization

Education

Age

Political Culture

Internal Determinants

Nursing Home

State Surveying Agency

Legislature

Interest Groups

Governor

Possible Predictors of the Extent of State Regulatory Activity


Linear mixed model predicting state citation volume

Linear Mixed Model Predicting State Citation Volume


Linear mixed model predicting state citation severity

Linear Mixed Model Predicting State Citation Severity


Citation volume effect of governor s political party

Citation Volume: Effect of Governor’s Political Party


Citation severity effect of governor s political party

Citation Severity: Effect of Governor’s Political Party


Future use of the linear mixed model

Future Use of the Linear Mixed Model

  • Repetitive Scheduling of Annual Inspections: States are to avoid inspecting a nursing home during the same month in consecutive years

  • Deficiency Resolution: States are to resolve non-actual harm deficiencies within 60 days and actual harm deficiencies within 30 days


Contact information

Contact Information

Christopher M. Kelly, Ph.D.

CPHAR Post Doctoral Fellow

Institute on Aging

University of North Carolina at Chapel Hill

Tel 919 843 8065

[email protected]


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