Quality of Care and California Nursing Homes:
BACKGROUND: Despite substantial expenditures and considerable legislative and regulatory oversight, the caliber of care in U.S. nursing facilities (NFs) is poor and has long engendered calls from various constituencies to improve quality. OBJECTIVE: The primary aim of this study was to evaluate relationships between staffing and organizational characteristics and five measures of quality including total deficiencies (state + federal), validated complaints, and three federal quality indicators (QIs): weight loss, restraint use and bedfast status. SAMPLE AND DESIGN: The study population included 1,080 free-standing California NFs. Cross-sectional federal and state data, from 2004-2005, were evaluated with regression models that included controls for resident and market factors. RESULTS: The weight loss model accounted for 16% of the variation in QI prevalence. Higher percentages of Hispanic individuals in the operating market and more African American and Asian residents in each facility were associated with less weight loss. In contrast, more Medicare resident days and higher case mix were positively related to weight loss. For restraints, the model accounted for 10% of the variation in QI prevalence. Facility size (number of beds), higher staffing levels and for-profit ownership predicted more restraint use. Chain membership and increased percentages of Asian, Hispanic and African American residents predicted less restraint use. The bedfast QI was negatively associated with the presence of both a family council and more Asian and Hispanic residents, but positively associated with increased Medi-Cal (Medicaid) resident days and increased acuity. For complaints and deficiencies, more beds, increased staff turnover and more Medi-Cal days predicted more complaints and deficiencies. Elevated resident case mix also predicted more complaints, while increasing dependency and more Asian and Hispanic residents predicted fewer complaints. For-profit status predicted more deficiencies, while higher net income, increased percentages of African American and Hispanic residents (at the county level), and more Asian residents in ecah NFs predicted fewer deficiencies. IMPLICATIONS: As expected, the quality outcomes were related to various organizational and staffing characteristics. The favorable relationships between quality outcomes and increased racial/ethnic diversity at the market and facility levels were unexpected and contrary to findings in extant literature, which clearly warrant further investigation.