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Charlene Harrington

Publications and source records attributed to Charlene Harrington.

46 records · Page 3Linked to original sources
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.

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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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Discharge planning, nursing home placement, and the Internet.

BACKGROUND: Effective discharge planning and well-coordinated case management related to nursing home (NH) placement are key services in acute-care hospitals. OBJECTIVES: (1) identify the individuals and important factors involved in the discharge planning process; (2) describe the types/sources of information used by discharge planners to recommend specific nursing homes for patients and families; and (3) determine which methods are used to evaluate the quality of US nursing homes (NHs). METHODS: Descriptive study, with a convenience sample of 41 discharge planners and case managers from California acute-care hospitals. RESULTS: This study found that patients, families, friends, and physicians are all involved in the discharge planning process along with discharge planners and/or case managers. Discharge planners/case managers were generally concerned about NH bed availability, geographic location, and financial considerations. Although the discharge planners and case managers were able to articulate important indicators of quality in NHs, such information was not routinely considered during discharge planning activities. CONCLUSIONS: Discharge planners and case managers need to play a more central role in the decision-making process related to the selection of a NH, especially because decisions are time-limited and can benefit from a well-planned discharge planning program that uses a variety of data on quality and costs. The widespread use of Internet-based information sources can be expanded to aid this process.

Attitude of Health Personnel↗
PubMedDate not supplied

Quality of care in nursing home organizations: establishing a health services research agenda.

Health services research has led to exciting new findings about the critical importance of the amount and type of nursing staff in nursing homes for improving the processes and outcomes of care. This paper reviews recent theoretical and research issues and outlines areas where research is needed. The nursing home research agenda for the future needs to concentrate on: (1) the relationship between structural measures of nursing (eg, staffing levels, education, turnover rates) and the outcomes and processes of care; (2) adequate processes of care and ways to improve the reliability of clinical outcome measures; (3) better ways to risk-adjust for resident characteristics; (4) the impact of nursing home characteristics (eg, ownership) and public policies (eg, reimbursement) on structural factors, processes, and outcomes; and (5) cost-effectiveness studies of nursing care at the organizational or system level.

Cost-Benefit Analysis↗
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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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Case study: development of and stakeholder responses to a nursing home consumer information system.

California Nursing Home Search (www.calnhs.org), launched in October 2002, provides information about nursing home quality to a broad range of stakeholders. This case study discusses the process of developing a consumer-oriented nursing home Web site and presents an analysis of postlaunch responses from a number of sources (i.e., media, outreach, Web site use, correspondence, meetings, interviews) to determine the impact of the site and how it can be improved and used as an example. Consumers found the Web site valuable, but some needed clarification on navigation. Providers had complaints about the use of quality ratings and concerns about public availability of the data. Most discharge planners and care managers do not use Internet resources to find facilities. Feedback, modifications, updates, and outreach are needed on a continuous basis to ensure the site is a helpful tool for all stakeholders.

California↗
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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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Medicaid home and community-based services: national program trends.

Long-term care (LTC) policymakers face mounting pressures to expand Medicaid home and community-based services while the cost of institutional provision continues to rise and consume the bulk of Medicaid LTC spending. This paper presents the latest program trends in the three Medicaid home and community-based services programs (waivers, home health, and state-plan personal care) and reports a national survey of cost control policies used on waiver programs in 2002. The findings show slowing annual rates of participation growth on individual programs, widespread use of cost controls on waivers including waiting lists, and the persistence of large interstate variations in Medicaid's provision of these services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

The personal assistance workforce: trends in supply and demand.

The workforce providing noninstitutional personal assistance and home health services tripled between 1989 and 2004, according to U.S. survey data, growing at a much faster rate than the population needing such services. During the same period, Medicaid spending for such services increased dramatically, while both workforce size and spending for similar services in institutional settings remained relatively stable. Low wage levels for personal assistance workers, which have fallen behind those of comparable occupations; scarce health benefits; and high job turnover rates highlight the need for greater attention to ensuring a stable and well-trained workforce to meet growing demand.

Activities of Daily Living↗