Nursing Home Quality

Nursing Homes and Nursing Home Residents

This discussion of nursing home quality necessarily occurs within the context of the current nursing home industry and resident population. On any given day, approximately 16,000 nursing homes in the United States provide care for roughly 1.6 million residents. Most nursing homes are for-profit, investor-owned enterprises operated by multifacil-ity chains. The average size of nursing homes is approximately 100 beds, with an occupancy level below 90%. Over two thirds of longer-stay nursing home residents receive their care under the auspices of state Medicaid programs. Recent data indicate that state Medicaid programs pay on average about $120 per day (over $40,000 annually) for care. Private-pay residents now pay an average of about $190 per day (almost $70,000 annually). The federal Medicare program pays the bulk of costs for shorter-stay residents.

Almost all nursing homes accept Medicaid and/or Medicare funds. Receipt of these public funds requires that a nursing home be licensed by the state and certified to participate in and receive payment from these programs. Licensure and certification carry with them an elaborate array of requirements about financial reporting and resident care. The most basic of these requirements involve annual cost reports and annual on-site surveys by multimember teams who evaluate the degree to which a nursing home meets state licensure and federal certification standards.

Most admissions to nursing homes (just over 50%) come from hospitals. A large number of individuals, over the course of a year, come into nursing homes and then either die or leave within weeks. These short-stay individuals who return home are largely in the nursing home to recover from some acute disease episode such as the flu or to recover from an acute exacerbation of a chronic disease condition such as diabetes or from physical, speech, or occupational rehabilitation after a fall or stroke. On any given day, these short-stay residents constitute about 10% of a nursing home's population, but they constitute over 60% of all individuals admitted annually to nursing homes. Only about one quarter to one third of those admitted to a nursing home will be in the same nursing home 3 months after admission.

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