Unlicensed care homes in the United States: a clandestine sector of long-term care.

Residential care facilities operating without a state license are known to house vulnerable adults. Such unlicensed care homes (UCHs) commonly operate illegally, making them difficult to investigate. We conducted an exploratory, multimethod qualitative study of UCHs, including 17 subject matter expert interviews and site visits to three states, including a total of 30 stakeholder interviews, to understand UCH operations, services provided, and residents served.

The interRAI Pediatric Home Care (PEDS HC) Assessment: Evaluating the Long-term Community-Based Service and Support Needs of Children Facing Special Healthcare Challenges.

The vast majority of assessment instruments developed to assess children facing special healthcare challenges were constructed to assess children within a limited age range or children who face specific conditions or impairments. In contrast, the interRAI Pediatric Home Care (PEDS HC) Assessment Form was specifically designed to assess the long-term community-based service and support needs of children and youth aged from four to 20 years who face a wide range of chronic physical or behavioral health challenges. Initial research indicates that PEDS HC items exhibit good predictive validity-explaining significant proportions of the variance in parents' perceptions of needs, case managers' service authorizations, and Medicaid program expenditures for long-term community-based services and supports.

Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services.

Background: Medicaid Personal Care Services (PCS) help families meet children's needs for assistance with functional tasks. However, PCS may have other effects on a child's well-being, but research has not yet established the existence of such effects.

Objectives: To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services.

Nursing homes and the affordable care act: a cease fire in the ongoing struggle over quality reform.

Most provisions in the Affordable Care Act that affect nursing homes originated in two earlier attempts at reform, both of which failed multiple times in prior Congressional sessions: the Elder Justice Act and the Nursing Home Transparency and Improvement Act. Both of these earlier efforts focused on improving quality and reducing elder abuse in nursing homes by strengthening oversight and enforcement penalties, expanding staff training, and increasing the information on nursing home quality available to consumers and regulators. Each bill addressed problems that were serious, widespread, and had persisted for years, but each failed to pass on its own.

Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items.

Background: To test the validity and reliability of scales intended to measure activity limitations faced by children with chronic illnesses living in the community. The scales were based on information provided by caregivers to service program personnel almost exclusively trained as social workers. The items used to measure activity limitations were interRAI items supplemented so that they were more applicable to activity limitations in children with chronic illnesses.

Severity of children's intellectual disabilities and Medicaid personal care services.

Objectives: This research investigated the relationship between a child's reported intellectual disability (ID) level and caregivers' reports of the child's health status to predict Medicaid Personal Care Services (PCS) hours authorized for that child. We also investigated how activity limitations in the home varied with the level of ID.

Design: The sample included 1,108 community-residing children with a reported level of ID in the Texas Medicaid system and who were assessed for the PCS program.

Medicaid Personal Care Services and caregivers' reports of children's health: the dynamics of a relationship.

Objective: To investigate the relationship between Medicaid Personal Care Services (PCS) and caregivers' reports of activity (activities of daily living [ADL]) limitations for children with chronic health problems.

Data Sources/study Setting: Primary data collected in 2008 and 2009. A state Medicaid program was the setting.

Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community.

Purpose: Meeting the personal care challenges of children with special health care needs (CSHCN) living in the community demands a reliable assessment of their abilities to perform activities of daily living (ADLs). This research investigates factors affecting the inter-rater reliability of functional assessments of CSHCN conducted in the home.

Methods: Dual-standardised assessments were conducted with 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single state in USA.

Defining quality in assisted living: comparing apples, oranges, and broccoli.

Purpose: The purpose of this article is to discuss and describe various measures of quality, quality indicators, and uses of information on quality with specific reference to the role or purpose of assisted living.

Design And Methods: We reviewed a variety of major studies of assisted living quality. We elaborated models of assisted living based on differing goals or claims made for it by providers and policy makers.

Providing appropriate services to individuals in the community: a preliminary case-mix for model allocating personal care services.

Personal care services are often provided to clients in community settings through highly discretionary processes. Such processes provide little guidance for caseworkers concerning how public resources should be allocated. The results of such processes almost guarantee that individuals with very similar needs will receive very different levels of care resources.

Comparing staffing levels in the Online Survey Certification and Reporting (OSCAR) system with the Medicaid Cost Report data: are differences systematic?

Purpose: This study had two goals: (a) to assess the validity of the Online Survey Certification and Reporting (OSCAR) staffing data by comparing them to staffing measures from audited Medicaid Cost Reports and (b) to identify systematic differences between facilities that over-report or underreport staffing in the OSCAR.

Design And Methods: We merged the 2002 Texas Nursing Facility Cost Report, the OSCAR for Texas facilities surveyed in 2002, and the 2003 Area Resource File. We eliminated outliers in the OSCAR using three decision rules, resulting in a final sample size of 941 of the total of 1,017 non-hospital-based facilities.

Where should Momma go? Current nursing home performance measurement strategies and a less ambitious approach.

Background: Nursing home performance measurement systems are practically ubiquitous. The vast majority of these systems aspire to rank order all nursing homes based on quantitative measures of quality. However, the ability of such systems to identify homes differing in quality is hampered by the multidimensional nature of nursing homes and their residents.

Prospects and pitfalls: use of the RAI-HC assessment by the Department of Veterans Affairs for home care clients.

Purpose: The U.S. Department of Veterans Affairs has adopted two functional assessment systems that guide care planning: one for nursing home residents (the Resident Assessment Instrument [RAI]) and a compatible one for home care clients (RAI-HC).

Effect of staff turnover on staffing: A closer look at registered nurses, licensed vocational nurses, and certified nursing assistants.

Purpose: We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels.

Design And Methods: We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the Area Resource File for 2003.

Differences between newly admitted nursing home residents in rural and nonrural areas in a national sample.

Purpose: Previous research in specific locales indicates that individuals admitted to rural nursing homes have lower care needs than individuals admitted to nursing homes in urban areas, and that rural nursing homes differ in their mix of short-stay and chronic-care residents. This research investigates whether differences in acuity are a function of differences in resident payer status and occur for both individuals admitted for short stays, with Medicare as payer, and those needing chronic care.

Design And Methods: We used a representative 10% sample of national resident assessments (Minimum Data Set) for calendar year 2000 (N = 197,589).

Urban and rural differences in end-of-life pain and treatment status on admission to a nursing facility.

Individuals receiving end-of-life (EOL) care may have needs that are unrecognized or treated inappropriately. Yet, very little is known about differences in pain and special-care needs of EOL patients admitted to rural nursing facilities compared with urban nursing facilities, and whether the differing payer mix in urban and rural facilities affects the treatment ordered on admission. We examine a nationally representative sample of 6084 EOL patients upon admission to nursing homes to examine differences in diseases, pain assessments, and treatment orders.

Assisted living in rural America: results from a national survey.

Context: Expanding the availability of long-term care (LTC) services and making them more responsive to consumer preferences is an important goal, particularly for elderly people living in rural areas who tend to be older and have greater functional limitations but less access to the range of LTC options available in metropolitan areas. One option that has been growing in popularity is assisted-living facilities (ALFs).

Purpose And Methods: This paper describes rural ALFs and compares them with metropolitan ALFs.

Medicare expenditures for residents in assisted living: data from a national study.

Objective: To provide preliminary data on Medicare expenditures for assisted living facility (ALF) residents and to investigate whether ALF characteristics were related to Medicare expenditures for ALF residents.

Data Sources/study Setting: Data from the National Study of Assisted Living for the Frail Elderly conducted in 1998-1999. This analysis was restricted to the 40 percent of ALFs in that sample that adhered to the assisted living (AL) philosophy by offering more than minimal levels of services and privacy.

Rurality and nursing home quality: results from a national sample of nursing home admissions.

Objectives: We examined differences in quality of care among nursing homes in locales of varying degrees of rurality.

Methods: We classified locales into 4 classes according to rurality. We analyzed a 10% sample of nursing home admissions in the United States in 2000 (n=198613) to estimate survival models for 9 quality indicators.

A national survey of assisted living facilities.

Purpose: Throughout the 1990s, assisted living was the most rapidly growing form of senior housing. The purpose of this paper is to describe the existing supply of assisted living facilities (ALFs) and examine the extent to which they matched the philosophy of assisted living.

Design And Methods: The study involved a multistage sample design to produce nationally representative estimates for the ALF industry.

Effects of facility characteristics on departures from assisted living: results from a national study.

Purpose: Assisted living is an increasingly important residential setting for the frail elderly person. How often and why residents leave such facilities are important issues for consumers, for clinicians advising frail patients on their options for living arrangements, and for policymakers. This research investigated the impact of facility and individual characteristics on residents' departures from assisted living.