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Biomedical subjects

Charlene Harrington

Publications and source records attributed to Charlene Harrington.

13 recordsLinked to original sources
PubMed2003

Designing a report card for nursing facilities: what information is needed and why.

PURPOSE: This article presents a rationale and conceptual framework for making comprehensive consumer information about nursing facilities available. Such information can meet the needs of various stakeholder groups, including consumers, family/friends, health professionals, providers, advocates, ombudsman, payers, and policy makers. DESIGN AND METHODS: The rationale and framework are based on a research literature review of key quality indicators for nursing facilities. RESULTS: The findings show six key areas for information: (a) facility characteristics and ownership; (b) resident characteristics; (c) staffing indicators; (d) clinical quality indicators; (e) deficiencies, complaints, and enforcement actions; and (f) financial indicators. This information can assist in selecting, monitoring, and contracting with nursing facilities. IMPLICATIONS: Model information systems can be designed using existing public information, but the information needs to be enhanced with improved data.

Information Dissemination↗
PubMed2003

Nursing home staffing, turnover, and case mix.

This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,555), using staffing data from state cost reports in 1999. This study used a two-stage least squares model, taking into account nursing turnover rates, resident case mix levels, and other factors. As expected, total nurse and RN staffing hours were negatively associated with nurse staff turnover rates and positively associated with resident case mix. Facilities were resource dependent in that a high proportion of Medicare residents predicted higher staffing hours, and a higher proportion of Medicaid residents predicted lower staffing hours and higher turnover rates. Nursing assistant wages were positively associated with total nurse staffing hours. For-profit facilities and high-occupancy rate facilities had lower total nurse and RN staffing hours. Medicaid reimbursement rates and multifacility organizations were positively associated with RN staffing hours.

Activities of Daily Living↗
PubMed2002

Regulation of nursing facilities in the United States: an analysis of resources and performance of state survey agencies.

PURPOSE: This study was undertaken to examine the resources, staffing, and performance of the state survey agencies that have primary responsibility for regulating nursing facilities-licensing them at a state level and certifying them for participation in Medicare and Medicaid on behalf of the Center for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration). DESIGN AND METHODS: A telephone and fax survey of survey agencies in all 50 states and the District of Columbia was used, supplemented by secondary data collected from CMS's On-Line Certification and Reporting (OSCAR) system. RESULTS: Total state agency expenditures on nursing facility regulation in 2000 were $382.2 million, which is less than one half of 1% of the total expenditures on nursing facilities in the United States. About 3,000 full-time equivalent surveyors are employed to regulate more than 17,000 nursing facilities in the United States. Nursing facility licensing and certification dominates the work of state survey agencies, although they are responsible for regulating many other health care organizations. Spending has risen recently, but resource levels vary greatly across states, and most state agencies report significant funding shortfalls that impact on their ability to perform their regulatory function. On a range of indicators, the performance of state survey agencies varies fivefold. Some of that state variation is explained by differences in resource levels for regulation, but most is not. IMPLICATIONS: State survey agencies probably need more funding to fulfill their responsibilities properly, but other changes are also needed to improve their performance, including more support and oversight by CMS and more effective regulatory design.

Nursing Homes↗
PubMed2002

Challenges and accomplishments of the second-generation social health maintenance organization.

PURPOSE: This study traces the implementation of the second-generation Social HMO demonstration program within the Health Plan of Nevada among more than 35,000 Las Vegas members. DESIGN AND METHODS: This case study uses health plan reports, claims data, and administrator and clinician interviews covering the years 1999-2001. RESULTS: Care coordination, geriatric services, communications, and support infrastructure development has been extensive. Implementation has occurred at different rates among staff model and network practice physicians. Hospital days and discharges were fewer among clinic than network participants; physician and emergency room visits were more frequent, as were day care, respite care, and home help. IMPLICATIONS: Integrating medical and social care is difficult. Despite great efforts, it took several years before key benefits could be adequately developed and linkages created. Evaluations that target start-up rather than steady-state operation may not capture these accomplishments. Further, federal government efforts to encourage experimentation and innovation in care for aged and disabled individuals may require programs other than time-limited demonstrations.

Health Maintenance Organizations↗
PubMed2002

Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home.

OBJECTIVE: To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES: The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS: Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS: We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS: Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.

Activities of Daily Living↗
PubMed2002

Access to community-based long-term care: Medicaid's role.

OBJECTIVE: The authors explore state variation in expenditures for Medicaid community-based care services for the period 1990 to 1997. METHOD: A random effects panel model is used to explore the relationship between state demographic, supply, economic, programmatic, and political factors and states' Medicaid community-based care expenditures. RESULTS: Although states increased provision of services over the study period, significant state-level variation was evident. Expenditures were positively associated with state per capita income, regulation of nursing home bed supply, and the number of Medicare home health users but were negatively related to nursing home bed supply. CONCLUSIONS: Recent legal rulings, combined with the demonstrated preferences of most individuals to receive care in the community, require policies to foster the expansion of Medicaid community-based care. The most consistent relationships that are amenable to policy intervention relate to state fiscal resources and long-term care supply regulation.

Aged↗
PubMed2002

Does investor-ownership of nursing homes compromise the quality of care?

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

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PubMedDate not supplied

Federal and state nursing facility websites: just what the consumer needs?

Since the introduction of the Medicare Nursing Home Compare website in 1999, some states have begun to develop their own websites to help consumers compare nursing facilities (NFs). This article presents a brief conceptual framework for the type of information needed for an Internet-based information system and analyzes existing federal and state NF websites, using data collected from a survey completed in 2002. Twenty-four states and the District of Columbia have a variety of information on NFs, similar to the information on the Medicare website. Information on characteristics and deficiencies of a facility is the most commonly available, but a few states have data on ownership, staffing indicators, quality indicators, complaints, and enforcement actions. Other types of data, such as resident characteristics, staff turnover rates, and financial indicators, are generally not available. Although many states are making progress toward providing consumers with information, there are gaps that exist, which if filled, could provide consumers with a better tool for facility selection and monitoring the quality of care.

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PubMedDate not supplied

Who cares for older adults? Workforce implications of an aging society.

There is a critical shortage of geriatrics-prepared health care professionals. In 2002 more than thirty-five million people were age sixty-five and older, and 23 percent of them reported poor or fair health. Older adults use 23 percent of ambulatory care visits and 48 percent of hospital days, and they represent 83 percent of nursing facility residents. Yet 58 percent of baccalaureate nursing programs have no full-time faculty certified in geriatric nursing. Only three of the nation's 145 medical schools have geriatrics departments, and less than 10 percent of these require a geriatrics course. We argue that every health care worker must have some education in geriatrics and access to geriatrics care experts.

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