Determinants of Nursing Home Regulatory Activity in the 50 States: An Analysis from the Political Ec

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Determinants of Nursing Home Regulatory Activity
in the 50 States An Analysis from the Political
Economy Perspective

• Christopher M. Kelly, Phoebe S. Liebig, and Lloyd
  J. Edwards
• SAMSI Transition Workshop
• November 10, 2005

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Acknowledgments

• Dr. Kelly was supported in part by a postdoctoral
  fellowship1 in the Carolina Program in Health and
  Aging Research (CPHAR) at the University of North
  Carolina at Chapel Hill
• 1Grant ST32AG00272 from the National Institute on
  Aging

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Nursing Home Regulation in the United States

• Under OBRA 87, states survey nursing homes, CMS
  oversees
• State surveyors rate nursing home deficiencies
  according to scope and severity
• Information is available to consumers on CMSs
  Nursing Home Compare website

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Research Questions

• What is the extent of nursing home regulatory
  activity in the 50 states?
• How did extent change over a three-year period?
• What factors predict citation volume severity
  in the 50 states?

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Political Economy Perspective
Age
Race
State Citizen/Public Sex/Gender
Capital
Class
Ideology
Estes (2001)
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Linear Mixed Model

• Used to identify predictors of the volume and
  severity of state citations
• Provides estimation and hypothesis testing for
  modeling population and random effects
• Can accommodate data missing completely at random

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Linear Mixed Model is Useful for Studying State
Regulatory Activity

• Longitudinal data (i.e. nursing home quality over
  several years)
• Population data - 50 U.S. states.
• Large sample techniques are challenged.
• Parsimonious model needed (N 50)
• Random intercept and slope.
• Within-subject errors assumed i.i.d.

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Nursing Home Deficiencies Stable, but Less Severe

• Number of deficiencies has remained level (about
  6 per nursing home)
• Percentage of severe deficiencies has declined
  (about 7 of all deficiencies cause actual harm)
• States vary widely in volume severity of
  deficiency citations

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Possible Predictors of the Extent of State
Regulatory Activity

• External Determinants
• Urbanization
• Education
• Age
• Political Culture

• Internal Determinants
• Nursing Home
• State Surveying Agency
• Legislature
• Interest Groups
• Governor

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Linear Mixed Model Predicting State Citation
Volume
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Linear Mixed Model Predicting State Citation
Severity
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Citation Volume Effect of Governors Political
Party
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Citation Severity Effect of Governors Political
Party
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Future Use of the Linear Mixed Model

• Repetitive Scheduling of Annual Inspections
  States are to avoid inspecting a nursing home
  during the same month in consecutive years
• Deficiency Resolution States are to resolve
  non-actual harm deficiencies within 60 days and
  actual harm deficiencies within 30 days

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Contact Information

• Christopher M. Kelly, Ph.D.
• CPHAR Post Doctoral Fellow
• Institute on Aging
• University of North Carolina at Chapel Hill
• Tel [phone]
• ckelly_at_schsr.unc.edu