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Nicholas G Castle

Publications and source records attributed to Nicholas G Castle.

33 records · Page 2Linked to original sources
PubMed2005

Nursing home closures, changes in ownership, and competition.

This research examines the relationship of competition among nursing homes and the likelihood of their closure or change in ownership. The study uses nationally representative data from the 1992-1998 Online Survey, Certification, and Reporting system, and is supplemented with several other primary and secondary data sources. It is hypothesized that facilities located in more competitive environments will be more likely to close. Multinomial logistic regression analyses are employed to examine this hypothesis in a model containing organizational and aggregate resident characteristics, and market factors. The Herfindahl index is used as a measure of competition. The descriptive analysis shows that 621 nursing homes closed and 6,471 changed ownership from 1992 to 1998. The incidence rate of closures was .7% of facilities per year. The multivariate analysis shows that facilities located in more competitive environments were significantly more likely to close.

Aged↗
PubMed2004

Response formats and satisfaction surveys for elders.

PURPOSE: A factor common to the results of many satisfaction surveys of elders is a lack of response variability. Increasing response variability may be useful if satisfaction surveys of elders are to be productively used in the future. In this paper, we first examine elders' preferences between five response formats and then examine the response variability of these five commonly used formats. DESIGN AND METHODS: Satisfaction, demographic, and Short-Form 36 Health Survey data were self-reported by patients in four outpatient surgery centers during 1998 and 1999. We used six different survey instruments randomly given to 3,122 elders. Five instruments varied in response format (5-item Likert format, 5-item satisfaction format, 5-item valuation format, 4-item Chernoff faces, and 10-item visual analogue format). The sixth survey used all five different response sets, and then it asked for the respondents' preferences among the different response sets. RESULTS: A total of 2,450 questionnaires were examined (response rate of 78.5%). The response format using four Chernoff faces was liked the least, with only 5% of the respondents preferring this format. The 10-item visual analogue format (10VAF) was liked the most, with 39% of the respondents preferring this format. In addition, 10% more elders thought this format was easier to use than the second-place choice (i.e., 32% vs. 22%). The coefficient of variation for the 10VAF was also higher than those in identical domains using the other response formats. This would seem to indicate that the 10VAF is less prone to a ceiling effect than the other response formats. IMPLICATIONS: Our results show that elders have a preference for some response formats, and from the choices we gave them a 10VAF was preferred. The 10VAF also had more response variability then the other formats we tested.

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PubMed2004

Nursing homes with persistent high and low quality.

This article examines the concentration of low- and high-quality care within particular nursing facilities over time. The authors explore three different explanations for persistent low and high quality over time including the level of public reimbursement, the presence of bed constraint policies such as certificate-of-need and construction moratoria, and the role of consumer information. Using 1991 through 1999 data from the On-Line Survey, Certification, and Reporting system, the authors show that both low- and high-quality nursing home care is concentrated in certain facilities over time. Their results further show that public reimbursement and asymmetric information are both important factors in explaining why low quality persists over time in certain facilities.

Certificate of Need↗
PubMed2004

Facility charter and quality of care for board and care residents.

In this investigation structure, process, and outcome measures of quality in for-profit and not-for-profit board and care homes are compared. We find one structural measure (providing nursing care), three process measures (food quality, staff treat residents with respect, and staff verbally abuse residents), and two outcomes measures (cleanliness of the facility and complaints to Ombudsman) to be significant. Moreover, the directions of these effects are all consistent, with for-profit facilities rated more poorly that not-for-profit facilities. These results are discussed emphasizing their implications for efficient and effective resident care.

Accidental Falls↗
PubMed2003

Providing outcomes information to nursing homes: can it improve quality of care?

PURPOSE: This study examined whether providing outcomes information to 120 nursing homes facilitated improvements in quality over a 12-month period, as compared with 1,171 facilities not receiving this information. The outcomes information provided consisted of a report mailed to administrators that examined six measures of care quality. These were the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, psychotropic medication use, and certification survey quality of care deficiencies. DESIGN AND METHODS: Data used in this investigation came from the 1998 and 1999 On-line Survey, Certification and Recording (OSCAR) system. With the use of generalized least squares regression and each of the six quality indicators as dependent variables, risk-adjustment models were developed by using aggregate resident variables as independent variables. These risk-adjustment models were used to compare the outcome measures for the intervention facilities with the same outcome measures in other facilities in the same states (Kansas, Maine, Mississippi, New York, Texas, and South Dakota). The difference between 1998 predicted scores less actual scores was calculated, and the difference between 1999 predicted scores less actual scores for each facility was calculated. Subtracting these 1998 difference scores from the 1999 difference scores gives some indication of the change in outcomes controlling for resident mix. RESULTS: Physical restraint use and psychotropic medication use were significantly lower after 12 months in the intervention facilities, suggesting that quality had improved. IMPLICATIONS: This study may provide evidence that some of the outcomes initiatives currently being pursued in the long-term care arena will positively affect quality of care.

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PubMed2003

Consumer satisfaction in long-term care: state initiatives in nursing homes and assisted living facilities.

PURPOSE: We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. DESIGN AND METHODS: Data on state initiatives and programs were collected during March and April 2000 through a mailed questionnaire and follow-up telephone interviews and were current as of September 2002. RESULTS: Of the 50 states surveyed, 50 responses were received (response rate = 100%); 12 states (24%) reported the use of consumer satisfaction measures, and 7 (Florida, Iowa, Ohio, Oregon, Texas, Vermont, and Wisconsin) reported using resident satisfaction data within their consumer information systems for nursing homes or assisted living facilities. Additionally, 2 states (Iowa and Wisconsin) use resident satisfaction data for facility licensing and recertification. The design of the instruments and collection methods vary in these states, as do the reported response rates, per-resident cost, and the purpose for satisfaction data collection. IMPLICATIONS: State satisfaction efforts are in an early stage of development. Well-produced, easily understandable reports on nursing home and assisted living quality could provide information and guidance for patients and families contemplating the utilization of long-term care services. Dissemination of quality information may also facilitate sustained quality and efficiency improvements in long-term care facilities and thus enhance the quality of care for and quality of life of long-term care residents.

Assisted Living Facilities↗
PubMed2003

Searching for and selecting a nursing facility.

In this study, the authors present findings from 306 resident interviews matched with 306 family member interviews examining factors associated with both the search for and selection of a nursing facility. For many elders transitioning into a nursing facility, the facility becomes their home, and the average cost of residing in that home is high. As such, searching for and selection of a facility has important consequences. The authors found that residents are not very influential in these processes. Second, they found very few proactive nursing facility choices were made by either residents or family members. Third, the choices made were seldom based on the quality of the facility. Fourth, prior knowledge of the chosen facility was limited. Finally, the authors also show that the time taken to choose a facility was in most cases extremely limited.

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PubMed2002

Professional association membership by nursing facility administrators and quality of care.

This article compares 4,220 nursing homes whose administrators belonged to a long-term-care professional association to 12,322 nursing homes whose administrators did not belong to a long-term-care professional association. The research results show that professional membership is associated with higher quality of care on several measures and with a higher private-pay proportion. The study suggests that these facilities do not do better because they have more resources or because they care for less-challenging residents-they do better because they have a professional association as a resource.

Bed Occupancy↗
PubMed2002

Nursing homes with persistent deficiency citations for physical restraint use.

OBJECTIVES: This paper examines the organizational and aggregate resident characteristics of nursing homes associated with persistent poor quality in the use of physical restraints. Deficiency citations for physical restraint use in two and three consecutive certification survey inspections are used as our measures of poor quality. MATERIALS AND METHODS: Nationally representative data from the 1996, 1997, 1998, and 1999 Online Survey, Certification, and Reporting system are used, first, to provide descriptive analyses. Second, multinomial logistic regression analyses are used to examine organizational and aggregate resident characteristics associated with deficiency citations for restraint use on any survey inspection, on two consecutive inspections, and deficiencies for physical restraint use in three consecutive inspections. RESULTS: It is shown that 729 (5.2%) nursing homes had deficiency citations for restraint use on two consecutive inspections and 317 (2.3%) on three consecutive inspections. Persistent poor quality in the use of physical restraints in nursing homes is negatively associated to higher staffing levels of care givers, and positively associated to higher Medicaid census, and higher average activities of daily living (ADL) levels. CONCLUSION: The Nursing Home Reform Act has been extremely influential in reducing the overall prevalence of physical restraint use in nursing homes, but the number of facilities with persistent quality problems in their use of restraints in the face of this legislation is surprising. The organizational and aggregate resident characteristics of these nursing homes, especially RN staffing levels, Medicaid census, and average ADL levels differ from those that did not receive any deficiency citations for use of physical restraints.

Activities of Daily Living↗
PubMed2002

Low-care residents in nursing homes: the impact of market characteristics.

Approximately 30% of nursing home residents were recently identified as low-care cases; that is, residents with low levels of acuity. Other institutional venues, board and care homes and assisted living facilities, for example, are often recommended as alternative domiciliaries providing more appropriate and less expensive care for these residents. In this investigation the effect of nine market factors on the prevalence of low-care residents in 14,646 nursing homes are studied. Government regulations, competition from other providers, and the overall munificence of the market are found to influence their prevalence. These results are discussed along with several issues inherent to channeling low-care residents to other care setting.

Activities of Daily Living↗
PubMedDate not supplied

Strategic groups and outcomes in nursing facilities.

This article uses the Miles and Snow typology of strategies to examine nursing facilities' strategic responses to their changing environment and whether strategic responses are associated with facilities performance in quality outcomes. The author hypothesizes that prospector nursing facilities will have the highest quality outcomes, followed by defender, analyzer, and reactor facilities.

Catheterization↗
PubMedDate not supplied

Characteristics of nursing homes that close.

This study examined closures in the nursing home industry from 1992 to 1998. Data used in this investigation primarily came from the Online Survey Certification and Recording (OSCAR) system, representing 13,212 nursing homes. Descriptive analysis showed 607 nursing homes closed during this time. Our results are important. On the one hand, the results show that nursing homes are sensitive to their operating environment; on the other hand, the likelihood of closure is very small, representing less than 1 percent of facilities per year.

Bankruptcy↗
PubMedDate not supplied

Organizational commitment and turnover of nursing home administrators.

In this investigation, the associations between organizational commitment (OC), intent-to-turnover, and actual turnover of a large sample of nursing home administrators (NHAs) are examined. Data used come from a mail survey, from which 632 responses were received from the NHAs (response rate = 63%). The one-year turnover rate of NHAs was 39 percent, and in almost all cases (87%) these NHAs had also exhibited low OC scores. The intent-to-turnover results show thinking about quitting comes before searching for a new position, which in turn both comes before the intention to quit. Multivariate analyses show work overload has a strong and robust association with both intent-to-turnover and turnover of NHAs, and may indicate that NHAs are leaving their positions because they are understaffed.

Attitude of Health Personnel↗
PubMedDate not supplied

Downsizing in the nursing home industry.

Downsizing in the nursing home industry from 1992 to 2003 was examined. Most significantly, we show that downsizing is subsequently associated with improved quality.

Health Care Surveys↗