This article reports historical trend data on resident characteristics and conditions, problems, and deficiency patterns for nursing facilities from 1991 through 1997 from Health Care Financing Administration (HCFA) administrative records from the On-Line Survey, Certification, and Reporting System (OSCAR). Over this period, residents show some increases in dependency and conditions, although there was a decline in the use of restraints. The deficiencies reveal continued quality problems in some nursing homes, although the average number of deficiencies given to facilities declined by 44 percent between 1991 and 1997. The discussion considers possible explanations for the decline in deficiencies, including whether the quality of care in nursing homes has improved or whether the enforcement process has gradually been weakened.
Get full access to this article
View all access options for this article.
References
1.
Abt Associates and the U.S. Department of Health and Human Services. July 1998. Report to Congress: Study of private accreditation (Deeming of Nursing Homes, Regulatory Incentives and Non-Regulatory Initiatives, and Effectiveness of the Survey and Certification System). Volumes 1-4. Washington, DC: Health Care Financing Administration.
2.
Burton, L. C., P. S. German, B. W. Rovner, L. J. Brant, and R. D. Clark. 1992. Mental illness and the use of restraints in nursing homes. The Gerontologist32 (2): 164-170.
3.
California Advocates for Nursing Home Reform. 1998. 1998 report card: California nursing homes. San Francisco: California Advocates for Nursing Home Reform.
4.
Castle, N. G., and V. Mor. 1998. Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987. Medical Care Research and Review55 (2): 139-170.
5.
Edelman, T.1997. An unpromising picture: Implementation of reform law’s enforcement provisions troubles advocates. Quality Care AdvocateMarch: 1-46.
6.
Edelman, T.. 1998. What happened to enforcement?Nursing Home Law Letter1/2: 1-46.
7.
Evans, L., and N. Strumpf. 1989. Tying down the elderly. Journal of the American Geriatrics Society37: 65-74.
8.
Fries, B. E., C. Hawes, J. N. Morris, C. D. Phillips, V. Mor, and P. S. Park. 1997. Effect of the national resident assessment instrument on selected health conditions and problems. Journal of the American Geriatrics Society45: 994-1001.
9.
Fries, B. E., D. Schneider, M. Foley, M. Gavazzi, R. Burke, and E. Cornelius. 1994. Refining a case-mix measure for nursing homes: Resource utilization groups (RUGS-III). Medical Care32 (7): 668-685.
10.
Institute of Medicine, Staff and National Research Council Staff. 1986. Improving the quality of care in nursing homes. Washington, DC: National Academy Press.
11.
Kauffman, C.1996. Abuse & neglect: An investigative report on quad-city nursing homes. Quad-City Times. Series. 1 December through 8 December.
12.
Libow, L., and P. Starer. 1989. Care of the nursing home patient. New England Journal of Medicine321: 93-96.
Morris, J. N., K. Murphy, and S. Nonemaker. 1995. Long-term care facility Resident Assessment Instrument (RAI) user’s manual. RAI Version 2.0. Washington, DC: Health Care Financing Administration.
15.
Mukamel, D. B.1997. Risk-adjusted outcome measures and quality of care in nursing homes. Medical Care35 (4): 367-385.
16.
Omnibus Budget Reconciliation Act of 1987. 1987. Public law 100-203. Subtitle C: Nursing home reform. Signed by the president, Washington, DC, December 22.
17.
Palmer, M. H., R. G. Bennett, J. Marks, K. A. McCormick, and B. T. Engel. 1994. Urinary incontinence: A program that works. Journal of Long Term Care Administrationsummer: 19-25.
18.
Palmer, M. H., P. S. German, and J. G. Ouslander. 1991. Risk factors for urinary incontinence one year after nursing home admission. Research in Nursing & Health14: 405-412.
19.
Pear, R.1996. U.S. seeks to limit inspections’ scope at nursing homes. New York Times17 December: A1.
20.
Pear, R.. 1997. Big donors from nursing homes had access. New York Times23 April: A16.
21.
Pear, R.. 1999. Capital insider bemoans what he wished for. New York Times20 May: A18.
22.
Phillips, C. D., C. Hawes, and B. E. Fries. 1993. Reducing the use of physical restraints in nursing homes: Will it increase costs?American Journal of Public Health83 (3): 342-348.
23.
Phillips, C. D., J. Morris, C. Hawes, B. E. Fries, V. Mor, M. Nennstiel, and V. Iannac-chione. 1997. Association of the Resident Assessment Instrument (RAI) with changes in function, cognition, and psychosocial status. Journal of the American Geriatrics Society45: 986-993.
24.
Pyle, A.1999. Seeking a remedy for nursing homes’ ills. Los Angeles Times28 May: A1, A38-A39.
25.
Rarick, E.1995. Dignity in distress: State’s nursing homes not always the rock of aged. Contra Costa Times24 September: 1A, 4A-7a.
26.
Schnelle, J.1990. Treatment of urinary incontinence in nursing home patients by prompted voiding. Journal of the American Geriatrics Society38: 256-360.
27.
Schnelle, J. F., D. R. Newman, and T. Fogarty. 1990. Management of patient continence in long term care nursing facilities. The Gerontologist30: 373-376.
28.
Spector, W. D., and H. A. Takada. 1991. Characteristics of nursing homes that affect resident outcomes. Journal of Aging and Health3 (4): 427-454.
29.
Time. 1997. The good provider. 10 February: 32.
30.
USA Today. 1996. Squabble reveals flaws in nursing home scrutiny. 19 December: 14A.
31.
U.S. Department of Health & Human Services, Health Care Financing Administration. 1988. 42 CFR Parts 405, 442, and 488. Medicare and Medicaid; long-term care survey; final rule. Federal Register53 (117), 17 June.
32.
U.S. Department of Health & Human Services, Health Care Financing Administration. 1989. 42 CFR Parts 405, 442, 447, 483, 488, 489, and 498. Medicare and Medicaid; requirements for long-term care facilities; final rule with request for comments. Federal Register54 (21), 2 February.
33.
U.S. Department of Health & Human Services, Health Care Financing Administration. 1994. 42 CFR Parts 401, 431, 435, 440, 441, 442, 447, 483, 488, 489, and 498. Medicare and Medicaid programs; survey, certification and enforcement of skilled nursing facilities and nursing facilities; final rule. Federal Register59 (217), 10 November.
34.
U.S. Department of Health & Human Services, Health Care Financing Administration. 1995. State operations manual. Provider certification. Transmittal No. 273. June.
35.
U.S. Department of Health & Human Services, Health Care Financing Administration. 1995. State operations manual. Provider certification. Transmittal No. 274. June.
36.
U.S. Department of Health & Human Services, Health Care Financing Administration. 1998. HHS fact sheet: Assuring the quality of nursing home care. Washington, DC: Health Care Financing Administration, Press Office, 21 July.
37.
U.S. Department of Health & Human Services, Health Care Financing Administration. 1998. Survey activity summary for July 1, 1997 to June 30, 1998. Unpublished data. Baltimore: Health Care Financing Administration.
38.
U.S. General Accounting Office. 1987. Report to the chairman, Subcommittee on Health and Long-Term Care, Select Committee on Aging, House of Representatives. Medicare and Medicaid: Stronger enforcement of nursing home requirements needed. Washington, DC: U.S. General Accounting Office.
39.
U.S. General Accounting Office. July 1998. California nursing homes: Care problems persist despite federal and state oversight. Report to the Special Committee on Aging, U.S. Senate. GAO/HEHS-98-202. Washington, DC: U.S. General Accounting Office.
40.
U.S. General Accounting Office. 1999. Nursing homes: Additional steps needed to strengthen enforcement of federal quality standards. Report to the Special Committee on Aging, U.S. Senate. GAO/HEHS-99-46. Washington, DC: U.S. General Accounting Office.
41.
U.S. Health Care Financing Administration. On-Line Survey, Certification, and Reporting System. Baltimore: U.S. Health Care Financing Administration.
42.
U.S. Office of the Inspector General, Department of Health and Human Services. 1999. Nursing home survey and certification: Deficiency trends. OEI-02-98-00331. Washington, DC: U.S. Office of the Inspector General.
43.
Vladeck, B.1980. Unloving care: The nursing home tragedy. New York: Basic Books.
44.
11 October: 1A, 1A-1S-1A-8S.
45.
Zimmerman, D. R., S. L. Karon, G. Arling, B. R. Clark, T. Collins, R. Ross, and F. Sainfort. 1995. Development and testing of nursing home quality indicators. Health Care Financing Review16 (4): 107-127.
