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Quality of Care for Veterans in Community Nursing Homes

Johnson CE, Weech-Maldonado R, Jia H, Reker DM, Buchanan RJ, Laberge A. Quality of Care for Veterans in Community Nursing Homes. Paper presented at: AcademyHealth Annual Research Meeting; 2006 Jun 27; Seattle, WA.




Abstract:

Objective: This study examines the quality of care of nursing homes with Veterans Affairs (VA) per diem residents versus those without VA per diem residents. We hypothesize that because of VA oversight, nursing homes that serve per-diem veterans will maintain higher levels of multi-dimensional quality. Methods: Data consist of the Online Survey Certification and Reporting (OSCAR) for 1999-2002. The dependent variables include 1) structural measures of quality (whether a facility met the Center for Medicare and Medicaid Services' recommended staffing levels for certified nursing assistants(CNAs) and registered nurses (RNs)); 2) process measures of quality (number of residents that required tube feeding, new catheterization, and mobility restraints); and 3) outcome measures of quality (quality of care deficiencies, quality of life deficiencies, total deficiencies, actual harm citations, and number of new pressure sores). The independent variable consists of whether the facility has any veterans (when analyzing all facilities) or whether the facility has a high proportion of veterans (when analyzing VA per-diem facilities only). Control variables include size (beds), for-profit status, proportion of Medicaid and Medicare residents, chain affiliation, and proportion of residents that are bladder incontinent, bowel incontinent, and bedfast. Logistic regression or negative binomial regression is used to model the relationship between presence of VA per-diem residents and quality of nursing home care. Findings: Facilities with any veterans were less likely to meet nurse (CNA/RN) staffing standards; more likely to have patients that require tube feeding, new catheterizations, and mobility restraints; and were more likely to have actual harm citations and new pressure sores, plus quality of care, quality of life, and total deficiencies, than facilities without veterans. However, among VA per diem facilities, those with higher proportions of VA residents were less likely to have patients with restraints or with new pressure sores or to have an actual harm citation. Conclusions: These results raise some initial concerns about the quality of care for veterans within community nursing homes under the VA per-diem program. However, additional VA oversight, as implied by a greater proportion of VA residents, may make a difference in terms of quality of care.





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