OBRA 1987 and the quality of nursing home care

Kumar, Virender; Norton, Edward C.; Encinosa, William

doi:10.1007/s10754-006-6862-9

Cited by 9 publications

(15 citation statements)

References 56 publications

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“…For example, home health care quality measures were recently released by the Centers for Medicare and Medicaid Services http://www.medicare.gov/hhcompare/home.asp and could be useful in the context of informal care. Alternatively, one could adapt measures from outcome-based measures of nursing home quality such as acquired pressure sores [27], use of restraints [27,28] or urinary tract infections [29]. Finally, indirect measures of quality of caregiving (e.g., care recipient's receipt of annual flu shots [30]) could also be useful.…”

Section: Discussionmentioning

confidence: 99%

An organizing framework for informal caregiver interventions: detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts

2011

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BackgroundCaregiver interventions may help improve the quality of informal care. Yet the lack of a systematic framework specifying the targets and outcomes of caregiver interventions hampers our ability to understand what has been studied, to evaluate existing programs, and to inform the design of future programs. Our goal was to develop an organizing framework detailing the components of the caregiving activities and the caregiver and care recipient outcomes that should be affected by an intervention. In so doing, we characterize what has been measured in the published literature to date and what should be measured in future studies to enable comparisons across interventions and across time.MethodsOur data set comprises 121 reports of caregiver interventions conducted in the United States and published between 2000 and 2009. We extracted information on variables that have been examined as primary and secondary outcomes. These variables were grouped into categories, which then informed the organizing framework. We calculated the frequency with which the interventions examined each framework component to identify areas about which we have the most knowledge and under-studied areas that deserve attention in future research.ResultsThe framework stipulates that caregiver interventions seek to change caregiving activities, which in turn affect caregiver and care recipient outcomes. The most frequently assessed variables have been caregiver psychological outcomes (especially depression and burden) and care recipient physical and health care use outcomes.ConclusionsBased on the organizing framework, we make three key recommendations to guide interventions and inform research and policy. First, all intervention studies should assess quality and/or quantity of caregiving activities to help understand to what extent and how well the intervention worked. Second, intervention studies should assess a broad range of caregiver and care recipient outcomes, including considering whether expanding to economic status and health care use of the caregiver can be accommodated, to ease subsequent economic evaluations of caregiving. Third, intervention studies should measure a common set of outcomes to facilitate cross-time and cross-study comparisons of effectiveness.

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Section: Discussionmentioning

confidence: 99%

An organizing framework for informal caregiver interventions: detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts

2011

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“…The nursing home market is one of the most highly regulated markets in the United States (Kumar, Norton, & Encinosa, 2006; X. Zhang & Grabowski, 2004).…”

Section: Theory and Literature Reviewmentioning

confidence: 99%

The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels

et al. 2015

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This study investigated the impact of state nursing home staffing standards on nurse staffing levels for the year 2011. Specifically, the study attempted to measure state staffing standards at facility level (i.e., nurse staffing levels that each individual nursing home must retain by its state staffing standards) and analyzed the policy impact. The study findings indicated that state staffing standards for the categories of registered nurse, licensed nurse, or total nurse are positively related to registered nurse, licensed nurse, or total nurse staffing levels, respectively. Nursing homes more actively responded to licensed staffing requirements than total staffing requirements. However, nursing homes did not increase their staffing levels as much as those required by state staffing standards. It is possibly because the quality-oriented inspection allows flexibility in nursing homes' control of nurse staffing levels.

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“…OBRA-87 undoubtedly changed nursing home care in many ways. Some empirical research has attributed OBRA-87 as successfully influencing quality (Shea, Russo, & Smyer, 2000), whereas some studies have identified a relatively small influence on quality (Kumar, Norton, & Encinosa, 2006). However, OBRA-87 was a watershed event in ways other than its influence on quality.…”

Section: Policy Initiatives and Qualitymentioning

confidence: 99%