Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies.

Objective: To compare staffing levels and deficiencies of the 10 largest U.S. for-profit nursing home chains with five other ownership groups and chain staffing and deficiencies before and after purchase by four private equity (PE) companies.

Variation in the use of federal and state civil money penalties for nursing homes.

Purpose: The study examined factors associated with state variations in the use of federal and state civil money penalties (CMPs) for nursing homes.

Design And Methods: We collected federal and state CMP data from state survey and certification agencies for 2004. We also used federal CMP data from the federal enforcement action database for 2000-2004.

Developing personal care programs: national trends and interstate variation, 1992-2002.

This paper examines the development of programs delivering personal care to the elderly and disabled. First, we report the latest national participant and expenditure trend data for the three main personal care programs: the Medicaid Personal Care Services (PCS) benefit, Medicaid 1915(c) waivers, and the Older Americans Act Title III. Second, to examine interstate variation revealed in the trend analysis, we present three time-series regression models of personal care development (expenditures, participants, and existence of PCS benefit) that control for state socioeconomic, political, policy, and provider characteristics.

Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.

Objective: To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates.

Medicaid community-based programs: a longitudinal analysis of state variation in expenditures and utilization.

As states face challenges posed by budget crises and pressures to develop Medicaid home and community-based services (HCBS), this paper provides a longitudinal analysis of state variation in expenditures and utilization for three HCBS programs (waivers, home health and personal care), and for total Medicaid HCBS. The first part of the analysis describes the nature and scope of state variation for each program in 1999, using such measures as participants per 1,000 population and expenditures per capita. The second part of the analysis presents time-series regression models that estimate sociodemographic, state policy, and market factors associated with intra-state variation in waiver participants and expenditures, and home health, personal care and total HCBS expenditures for the period 1992-99.

State nursing home enforcement systems.

This study presents interview and statistical data from a telephone and fax survey of state agency officials and statistical data from the Centers for Medicare & Medicaid Services' Online Survey Certification and Reporting (OSCAR) system. State survey activities for nursing facilities were reviewed and the number and types of intermediate sanctions issued by states in 1999 were reported, along with barriers to the use of such sanctions. Using five selected enforcement measures to create a summary score, states were classified by quartiles based on the stringency of their nursing facility enforcement activities.

Does investor-ownership of nursing homes compromise the quality of care?

Quality problems have long plagued the nursing home industry. While two-thirds of U.S.