Although many factors, including the increase in home care utilization and assisted living facilities, and reimbursement changes for Medicare and Medicaid, may impact this decline, it is also unknown whether there were geographic variations in the decline of availability of nursing home care, whether such variations persisted over time, whether there were geographic variations in quality of nursing home care, and whether there were geographic variations in the relationship between availability of care and quality of care. The number of nursing homes declined in the same period and then stabilized in 2014. Nevertheless, two recent reports have found that the utilization of nursing home care has declined over time between 20, the number of nursing home residents aged 65 years or older declined by 20%. The need for nursing home care may be expected to increase with the aging population in the United States. High star-rated nursing homes represent high quality of care and studies found that these nursing homes gain more residents. The Centers for Medicare & Medicaid Services (CMS) launched the Five-Star Quality Rating System in 2008 to publicly report nursing home performance. Given the importance of nursing homes, national efforts have been initiated to monitor and improve the quality of such care. Nursing home care is associated with shorter hospital stays and lower hospital costs and has been reported to improve patients’ health and quality of life, and lower rates of unplanned readmissions. Approximately 30% (1.5 million) of hospitalized Medicare beneficiaries are referred to nursing homes at hospital discharge. The proportion of Medicare residents has increased over time. Among nursing home residents, approximately 65% are long-term residents who receive care under Medicaid and 13% are short-term residents who receive post-acute care under Medicare. In the United States, there were more than 15,600 nursing homes with 1.7 million licensed beds providing care to 1.4 million residents in 2015. Nursing homes, which provide institutional care to patients who cannot to be cared for at home and need 24-h nursing supervision and/or extensive custodial care, play an important role for individuals needing such care, especially among older adults. Availability and quality of nursing home care were not highly correlated. Availability of all nursing home care declined but availability of 5-star nursing home care increased. We observed persistent geographic variations in availability and quality of nursing home care. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division.
From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30–0.36). The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51–0.56). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged ≥65 years. Persistent geographic variation in availability of nursing home care was observed the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77–0.79). Resultsįrom 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged ≥65 years. Outcomes were 1) availability of all nursing home care (1996–2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged ≥65 years, regardless of nursing home star rating 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds. Retrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996–2016. We sought to assess geographic variation in availability and quality of nursing home care.
Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S.
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