In this study, data from the 1987 Medicare and Medicaid Automated Certification Survey
(MMACS) is analyzed to determine the extent to which nursing home staffing and resident care
management practices, such as urethral catheterization and physical restraint use, vary across
a sample of 10 standard metropolitan statistical areas (SMSAs). After controlling for influential
differences in case mix related to facility characteristics and the functional severity of the nursing
home population at risk, significant SMSA effects associated with staffing and practice outcome
measures were found by weighted least squares regression. Potential sources of variation related
to local market conditions and state nursing home policy are considered.
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