Disparities in the Quality of Nursing Home Care

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ABSTRACT The quality of nursing home care is an essential issue for the health and well-being of the elderly. For decades, there have been widespread concerns about the quality of nursing home care in the US, as well as disparities in the quality of care received across different groups. Exacerbating these issues are worries about the ability of patients (or their caregivers) to assess nursing home quality, an issue that is particularly acute for patients with Alzheimer’s disease or a related dementia (ADRD). We propose to document the extent of disparities in the quality of Medicare-covered nursing home care received, to investigate the forces behind those disparities, and to evaluate the impact of potential policy interventions. We will focus on disparities across racial groups (specifically Black non-Hispanic patients compared to White non-Hispanic patients), ethnic groups (Hispanic patients compared to non-Hispanic patients), socio-economic status (patients dually-enrolled in Medicaid at admission or not), and health groups (patients with and without ADRD on admission). To accomplish this, we will build on our existing work estimating average value-added for each nursing home. We created a measurement framework for estimating this value-added that can be applied to any health measure (or combination of health measures) in the rich data on patient physical health, mental health, daily functioning, dementia, and cognitive capacity available in the Centers for Medicare and Medicaid Services’ Minimum Data Set; these assessments cover all patients in Medicare and Medicaid certified nursing homes. We propose to expand our framework to allow value added to differ across different groups of patients within each nursing home, and then to use it to document the extent of disparities in nursing home quality experienced by group. Then we will examine the disparities in value-added to determine what can be attributed to differential treatment of patients within the same nursing home as opposed to different allocation of patients across nursing homes. We will analyze the likely impact of alternative public policies on these disparities and the health outcomes of nursing home residents. We aim to shed light on both the sources of disparities and the potential of different types of policies on reducing disparities.