A research article first published on October 29, 2024 entitled “Impact of skilled nursing facility quality on Medicare beneficiaries with dementia: Evidence from vacancies” concluded: “People living with dementia are less likely to be admitted to high-rated nursing homes than people without dementia, despite their increased care needs.”
“In this study, we investigated the effect of being treated at nursing homes with higher quality ratings for staffing on mortality and readmission and whether the effects differed for patients with dementia … We find that admission to a better-staffed nursing home was associated with reduced hospital readmission and mortality overall. However, the impact of entering a better-staffed nursing home on these outcomes was stronger for patients with dementia. For instance, if a patient’s destination nursing home’s staffing star rating was greater by one, the probability of 30-day readmission decreases by 0.34 percentage points if the patient does not have dementia and by 0.81 percentage points if the patient has dementia … Although persons with dementia strongly benefit from higher nursing home quality, they are less likely to be admitted to high-quality facilities, indicating welfare loss from inequitable access.”
What Needs To Be Done
“Our findings speak to not only the need for more staffing broadly, but also to how staffing is allocated across patient populations. The fact that patients with dementia are less likely to receive nursing home care in facilities with better staffing, but may especially benefit from it implies inefficiency in how quality is currently allocated. As such, reducing disparities in nursing home quality for persons with dementia will not only enhance equity but also may enhance social welfare. However, there are no simple policy levers to achieve this. Prioritizing better staffing at lower-rated facilities is a seemingly obvious remedy, but historical evidence for substantial quality improvement at poor-performing nursing homes is lacking. Relatedly, preferences for nursing homes nearby to individuals’ residences typically outweigh preferences for facility quality, and persons with dementia are typically situated near lower-quality facilities. A more feasible approach for improving the quality of care received by persons with dementia is increasing access to higher-rated facilities. Public reporting is a tool historically used to improve access by placing market pressure on facilities to improve. Although facilities with lower ratings lose market share theoretically, consumers with cognitive impairment or reduced access to technology may be less like to use public report cards. More active efforts by hospital discharge planners may be warranted to ensure persons with dementia are placed in higher-quality nursing homes that are not simply nearby their residences.
Incentivizing nursing homes to treat patients with dementia is another potential avenue for reform. Historically, nursing homes have been reimbursed based on the level of skilled therapies provided with rudimentary case mix adjustment. It is likely that patients with dementia both generate low revenues and also have high ancillary costs associated with their care. For instance, a patient with dementia may be unable to tolerate large amounts of therapy and also require uncompensated behavioral symptom management. Under a different payment mechanism and better risk adjustment, higher-quality nursing homes may find it more worthwhile to serve patients with dementia.”
If you or a loved one may have been injured (or worse) in a nursing home in the United States due to nursing home staff shortage, nursing home pressure ulcer (nursing home bedsore), a nursing home infection, nursing home fall, nursing home aspiration, nursing home neglect, nursing home negligence, nursing home abuse, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home malpractice lawyer who may investigate your nursing home malpractice claim for you and represent you or your loved one in a nursing home malpractice case, if appropriate.
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