The Experts below are selected from a list of 315 Experts worldwide ranked by ideXlab platform
David C Grabowski - One of the best experts on this subject based on the ideXlab platform.
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private investment purchase and Nursing Home financial health
Health Services Research, 2015Co-Authors: S Rebecca Orfaly M Cadigan, David G Stevenson, J Daryl S M Caudry, David C GrabowskiAbstract:Objective To explore the impact of Nursing Home acquisition by private investment firms on Nursing Home costs, revenue, and overall financial health. Data Sources Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998–2010. Study Design Regression specification incorporating facility and time fixed effects. Principal Findings We found little impact on the financial health of Nursing Homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired Nursing Home chains in good financial health, possibly to derive profit from the company's real estate holdings. Conclusions Private investment acquired facilities are an important feature of today's Nursing Home sector. Although we did not observe a negative impact on the financial health of Nursing Homes, this development raises important issues about ownership oversight and transparency for the entire Nursing Home sector.
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prospects for transferring Nursing Home residents to the community
Health Affairs, 2007Co-Authors: Vincent Mor, Zhanlian Feng, Orna Intrator, Jacqueline S Zinn, Pedro Gozalo, David C GrabowskiAbstract:The Deficit Reduction Act (DRA) of 2005 calls for states to develop strategies to “deinstitutionalize” Nursing Home residents. Using Minimum Data Set assessment data from 2005, we calculated the number of Nursing Home residents classified as “low-care” in each state using both a “narrow” and a “broad” definition. Between 5 percent (narrow) and 12 percent (broad) of the 1.4 million long-stay residents and similar proportions of new admissions remaining in a Nursing Home meet definitions for low care. States with lower investment in community alternatives had higher proportions of low-care Nursing Home residents.
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the costs and potential savings associated with Nursing Home hospitalizations
Health Affairs, 2007Co-Authors: David C Grabowski, James A Omalley, Nancy R BarhydtAbstract:Reducing Nursing Home hospitalizations has been identified as a possible area for cost savings, but little is known about the magnitude of spending associated with these hospitalizations. Using merged hospital and Nursing Home administrative files from New York State, we found that inflation-adjusted spending on Nursing Home hospitalizations increased 29 percent from 1999 through 2004. By 2004, aggregate spending totaled roughly $972 million, of which 23 percent was attributable to ambulatory care–sensitive conditions. These data highlight the potential for cost savings associated with programs designed to reduce these potentially avoidable hospitalizations from the Nursing Home setting.
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moral hazard in Nursing Home use
Journal of Health Economics, 2007Co-Authors: David C Grabowski, Jonathan GruberAbstract:Nursing Home expenditures are a rapidly growing share of national health care spending with the government functioning as the dominant payer of services. Public insurance for Nursing Home care is tightly targeted on income and assets, which imposes a major tax on savings; moreover, low state reimbursement for Medicaid patients has been shown to lower treatment quality, and bed supply constraints may deny access to needy individuals. However, expanding eligibility, increasing Medicaid reimbursement, or allowing more Nursing Home bed slots has the potential to induce more Nursing Home use, increasing the social costs of long-erm care. A problem in evaluating this tradeoff is that we know remarkably little about the effects of government policy on Nursing Home utilization. We attempt to address this shortcoming using multiple waves of the National Long-Term Care Survey, matched to changing state Medicaid rules for Nursing Home care. We find consistent evidence of no effect of Medicaid policies on Nursing Home utilization, suggesting that demand for Nursing Home care is relatively inelastic with respect to public program generosity. From a policy perspective, this finding indicates that changes in overall Medicaid generosity will not have large effects on utilization.
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moral hazard in Nursing Home use
National Bureau of Economic Research, 2005Co-Authors: David C Grabowski, Jonathan GruberAbstract:Nursing Home expenditures are a rapidly growing share of national health care spending with the government functioning as the dominant payer of services. Public insurance for Nursing Home care is tightly targeted on income and assets, which imposes a major tax on savings; moreover, low state reimbursement for Medicaid patients has been shown to lower treatment quality, and bed supply constraints may deny access to needy individuals. However, expanding eligibility, increasing Medicaid reimbursement, or allowing more Nursing Home bed slots has the potential to induce more Nursing Home use, increasing the social costs of long term care. A problem in evaluating this tradeoff is that we know remarkably little about the effects of government policy on Nursing Home utilization. We attempt to address this shortcoming using multiple waves of the National Long-Term Care Survey, matched to changing state Medicaid rules for Nursing Home care. We find consistent evidence of no effect of Medicaid policies on Nursing Home utilization, suggesting that demand for Nursing Home care is relatively inelastic. From a policy perspective, this finding indicates that changes in overall Medicaid generosity will not have large effects on utilization.
Jonathan Gruber - One of the best experts on this subject based on the ideXlab platform.
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moral hazard in Nursing Home use
Journal of Health Economics, 2007Co-Authors: David C Grabowski, Jonathan GruberAbstract:Nursing Home expenditures are a rapidly growing share of national health care spending with the government functioning as the dominant payer of services. Public insurance for Nursing Home care is tightly targeted on income and assets, which imposes a major tax on savings; moreover, low state reimbursement for Medicaid patients has been shown to lower treatment quality, and bed supply constraints may deny access to needy individuals. However, expanding eligibility, increasing Medicaid reimbursement, or allowing more Nursing Home bed slots has the potential to induce more Nursing Home use, increasing the social costs of long-erm care. A problem in evaluating this tradeoff is that we know remarkably little about the effects of government policy on Nursing Home utilization. We attempt to address this shortcoming using multiple waves of the National Long-Term Care Survey, matched to changing state Medicaid rules for Nursing Home care. We find consistent evidence of no effect of Medicaid policies on Nursing Home utilization, suggesting that demand for Nursing Home care is relatively inelastic with respect to public program generosity. From a policy perspective, this finding indicates that changes in overall Medicaid generosity will not have large effects on utilization.
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moral hazard in Nursing Home use
National Bureau of Economic Research, 2005Co-Authors: David C Grabowski, Jonathan GruberAbstract:Nursing Home expenditures are a rapidly growing share of national health care spending with the government functioning as the dominant payer of services. Public insurance for Nursing Home care is tightly targeted on income and assets, which imposes a major tax on savings; moreover, low state reimbursement for Medicaid patients has been shown to lower treatment quality, and bed supply constraints may deny access to needy individuals. However, expanding eligibility, increasing Medicaid reimbursement, or allowing more Nursing Home bed slots has the potential to induce more Nursing Home use, increasing the social costs of long term care. A problem in evaluating this tradeoff is that we know remarkably little about the effects of government policy on Nursing Home utilization. We attempt to address this shortcoming using multiple waves of the National Long-Term Care Survey, matched to changing state Medicaid rules for Nursing Home care. We find consistent evidence of no effect of Medicaid policies on Nursing Home utilization, suggesting that demand for Nursing Home care is relatively inelastic. From a policy perspective, this finding indicates that changes in overall Medicaid generosity will not have large effects on utilization.
Eiji Kajii - One of the best experts on this subject based on the ideXlab platform.
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The Nursing Home versus the hospital as the place of dying for Nursing Home residents in Japan.
Health Policy, 2007Co-Authors: Yayoi Takezako, Nanako Tamiya, Eiji KajiiAbstract:OBJECTIVES: To determine the characteristics of Nursing Home residents that are associated with dying in a Nursing Home versus a hospital in Japan. DESIGN: Retrospective case-control study. SETTING: A nonprofit Nursing Home with 110 beds in Tokyo, Japan. PARTICIPANTS: Eighty-six Nursing Home residents who died in the Nursing Home (n=43) or in a hospital (n=43) between 1 April 1999 and 30 September 2004. MEASUREMENTS: Nursing Home records were reviewed to gain information regarding the following domains: demography, the family decision-maker, health status, resident and family preference for Nursing Home end-of-life care, and presence of a full-time physician. RESULTS: The variables older age [adjusted odds ratio (adjusted OR)=1.08, 95% confidence interval (95% CI)=1.01-1.17], the family decision-maker's preference for Nursing Home end-of-life care (adjusted OR=3.95, 95% CI=1.21-12.84), and presence of a full-time physician (adjusted OR=3.74, 95% CI=1.03-13.63) were associated with dying in the Nursing Home. CONCLUSION: Older age, the family's preference for Nursing Home end-of-life care, and the presence of a full-time physician were significantly related to dying in the Nursing Home versus in a hospital.
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The Nursing Home versus the hospital as the place of dying for Nursing Home residents in Japan.
Health policy (Amsterdam Netherlands), 2006Co-Authors: Yayoi Takezako, Nanako Tamiya, Eiji KajiiAbstract:To determine the characteristics of Nursing Home residents that are associated with dying in a Nursing Home versus a hospital in Japan. Retrospective case-control study. A nonprofit Nursing Home with 110 beds in Tokyo, Japan. Eighty-six Nursing Home residents who died in the Nursing Home (n=43) or in a hospital (n=43) between 1 April 1999 and 30 September 2004. Nursing Home records were reviewed to gain information regarding the following domains: demography, the family decision-maker, health status, resident and family preference for Nursing Home end-of-life care, and presence of a full-time physician. The variables older age [adjusted odds ratio (adjusted OR)=1.08, 95% confidence interval (95% CI)=1.01-1.17], the family decision-maker's preference for Nursing Home end-of-life care (adjusted OR=3.95, 95% CI=1.21-12.84), and presence of a full-time physician (adjusted OR=3.74, 95% CI=1.03-13.63) were associated with dying in the Nursing Home. Older age, the family's preference for Nursing Home end-of-life care, and the presence of a full-time physician were significantly related to dying in the Nursing Home versus in a hospital.
Elizabeth A Rechtsteiner - One of the best experts on this subject based on the ideXlab platform.
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polypharmacy in Nursing Home residents in the united states results of the 2004 national Nursing Home survey
American Journal of Geriatric Pharmacotherapy, 2010Co-Authors: Lisa L Dwyer, Beth Han, David A Woodwell, Elizabeth A RechtsteinerAbstract:Background: Despite the need for and benefits of medications, polypharmacy (defined here as concurrent use of ≥9 medications) in Nursing Home residents is a concern. As the number of medications taken increases, so does the risk for adverse events. Monitoring polypharmacy in this population is important and can improve the quality of Nursing Home care. Objectives: The aims of this article were to estimate the use of polypharmacy in residents of Nursing Homes in the United States, to examine the associations between select resident and facility characteristics and polypharmacy, and to determine the leading therapeutic subclasses included in the polypharmacy received by these Nursing Home residents. Methods: This was a retrospective, cross-sectional study of a nationally representative sample of US Nursing Home residents in 2004; the outcome was use of polypharmacy. The 2004 National Nursing Home Survey was used to collect medication data and other resident and facility information. Resident characteristics included age, sex, race, primary payment source, number of comorbidities, number of activities of daily living (ADLs) for which the resident required assistance, and length of stay (LOS) since admission. Facility characteristics included ownership and size (number of beds). Results: Of 13,507 Nursing Home residents who received care, 13,403 had valid responses for all 9 independent variables in the analyses. The prevalence of polypharmacy among Nursing Home residents in 2004 was ~40%. A multiple regression model controlling for resident and facility factors revealed that the odds of receiving polypharmacy were higher for residents who were female (odds ratio [OR] = 1.10; 95% CI, 1.00–1.20), were white, had Medicaid as a primary payer, had >3 comorbidities (OR = 1.57–5.18; 95% CI, 1.36–6.15), needed assistance with <4 ADLs, had an LOS since admission of 3 to <6 months (OR = 1.25; 95% CI, 1.04–1.50), and received care in a small, not- for-profit facility (data not shown for reference levels [OR = 1.00]). The most frequently reported medications for residents who received polypharmacy included gastrointestinal agents (laxatives, 47.5%; agents for acid/peptic disorders, 43.3%), drugs that affect the central nervous system (antidepressants, 46.3%; antipsychotics or antimanics, 25.9%), and pain relievers (nonnarcotic analgesics, 43.6%; antipyretics, 41.2%; antiarthritics, 31.2%). Conclusions: Despite awareness of polypharmacy and its potential consequences in older patients, results of our analysis suggest that polypharmacy remains widespread in US Nursing Homes. Although complex medication regimens are often necessary for Nursing Home residents, monitoring polypharmacy and its consequences may improve the quality of Nursing Home care and reduce unnecessary health care spending related to adverse events.
Yayoi Takezako - One of the best experts on this subject based on the ideXlab platform.
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The Nursing Home versus the hospital as the place of dying for Nursing Home residents in Japan.
Health Policy, 2007Co-Authors: Yayoi Takezako, Nanako Tamiya, Eiji KajiiAbstract:OBJECTIVES: To determine the characteristics of Nursing Home residents that are associated with dying in a Nursing Home versus a hospital in Japan. DESIGN: Retrospective case-control study. SETTING: A nonprofit Nursing Home with 110 beds in Tokyo, Japan. PARTICIPANTS: Eighty-six Nursing Home residents who died in the Nursing Home (n=43) or in a hospital (n=43) between 1 April 1999 and 30 September 2004. MEASUREMENTS: Nursing Home records were reviewed to gain information regarding the following domains: demography, the family decision-maker, health status, resident and family preference for Nursing Home end-of-life care, and presence of a full-time physician. RESULTS: The variables older age [adjusted odds ratio (adjusted OR)=1.08, 95% confidence interval (95% CI)=1.01-1.17], the family decision-maker's preference for Nursing Home end-of-life care (adjusted OR=3.95, 95% CI=1.21-12.84), and presence of a full-time physician (adjusted OR=3.74, 95% CI=1.03-13.63) were associated with dying in the Nursing Home. CONCLUSION: Older age, the family's preference for Nursing Home end-of-life care, and the presence of a full-time physician were significantly related to dying in the Nursing Home versus in a hospital.
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The Nursing Home versus the hospital as the place of dying for Nursing Home residents in Japan.
Health policy (Amsterdam Netherlands), 2006Co-Authors: Yayoi Takezako, Nanako Tamiya, Eiji KajiiAbstract:To determine the characteristics of Nursing Home residents that are associated with dying in a Nursing Home versus a hospital in Japan. Retrospective case-control study. A nonprofit Nursing Home with 110 beds in Tokyo, Japan. Eighty-six Nursing Home residents who died in the Nursing Home (n=43) or in a hospital (n=43) between 1 April 1999 and 30 September 2004. Nursing Home records were reviewed to gain information regarding the following domains: demography, the family decision-maker, health status, resident and family preference for Nursing Home end-of-life care, and presence of a full-time physician. The variables older age [adjusted odds ratio (adjusted OR)=1.08, 95% confidence interval (95% CI)=1.01-1.17], the family decision-maker's preference for Nursing Home end-of-life care (adjusted OR=3.95, 95% CI=1.21-12.84), and presence of a full-time physician (adjusted OR=3.74, 95% CI=1.03-13.63) were associated with dying in the Nursing Home. Older age, the family's preference for Nursing Home end-of-life care, and the presence of a full-time physician were significantly related to dying in the Nursing Home versus in a hospital.
