Appalachian Nursing Homes: A Descriptive Analysis of Quality, Staffing, and Cost.
Academic Article
Overview
abstract
OBJECTIVE: To examine if the quality of care in Appalachian nursing homes in metropolitan, micropolitan, and rural areas differs from those in non-Appalachian regions of the United States. DESIGN: Retrospective analysis of Medicare Cost Reports, combined with data from Nursing Home Compare, LTCFocus, and Medicare, Post-Acute Care, and Hospice Public Use Form. Nursing homes were classified using Rural-Urban Commuting Area Codes. SETTING AND PARTICIPANTS: Data from 14,040 nursing homes reporting on staffing, costs, and quality of care metrics from 2013 to 2019 were analyzed. METHODS: Descriptive analyses compared resident and facility characteristics, quality, staffing, and cost outcomes between non-Appalachian and Appalachian nursing homes in metropolitan, micropolitan, and rural areas. Regressions compared quality, staffing, and cost outcomes among (1) Appalachian metropolitan and non-Appalachian nursing homes, (2) Appalachian micropolitan and non-Appalachian nursing homes, and (3) Appalachian rural and non-Appalachian nursing homes. Outcomes included health deficiency index scores, Medicare spending per beneficiary, staffing hours per resident day (registered nurse, licensed practical nurse, certified nursing assistant per resident day), and 5 Minimum Data Set metrics for short-stay and long-stay residents. RESULTS: Appalachian nursing homes are more likely to be hospital-based, for-profit, multifacility chain affiliated, and have higher proportions of White and Medicaid residents. Regression analyses revealed that Appalachian metropolitan nursing homes have 3.3% fewer certified nursing assistant hours per resident day, a 16.5% higher health deficiency score index, and 4.2% higher Medicare spending per beneficiary compared with non-Appalachian homes. Appalachian micropolitan nursing homes showed 7.4% fewer registered nurse hours per resident day and 6.9% higher Medicare spending per beneficiary. Appalachian rural nursing homes had 16.7% more registered nurse hours per resident day, 22.7% lower health deficiency index scores, and 10.7% higher Medicare spending per beneficiary. Minimum Data Set measures varied, with Appalachian nursing homes performing better on some metrics and worse on others. CONCLUSIONS AND IMPLICATIONS: Appalachia lags behind in staffing and Medicare spending per beneficiary. These disparities should be considered by policymakers advocating for Appalachia's senior citizens.
