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Background: Staffing ratios in nursing homes vary among the federal states of Germany, but there are no rational grounds for these variations. In a previous study, a new instrument for the standardized calculation of staffing requirements in nursing homes was developed (Algorithm1.0). The development was based on a new empirical data collection method that derives actual and target values for the time and number of care interventions provided. Algorithm1.0 found an increased requirement of 36% of staff in German nursing homes. Based on these results, the German legislature has commissioned a model program to trial and evaluate a complex intervention comprising increased staffing combined with strategies for organizational development. Methods: The mixed-methods study consists of (i) developing a concept for restructuring the work organization, (ii) the application of this concept combined with increased staffing in 10 nursing homes (complex intervention), and the further development of the concept using a participatory and iterative formal evaluation process. The intervention consists of (a) quantitative measures of increased staffing based on a calculation using Algorithm1.0 and (b) qualitative measures regarding organizational development. The intervention will be conducted over one year. The effects of the intervention on job satisfaction and quality of care will be evaluated in (iii) a comprehensive prospective, controlled summative evaluation. The results will be compared with ten matched nursing homes as a control group. Finally, (iv) prototypical concepts for qualification-oriented work organization, a strategy for the national rollout, and the further development of Algorithm1.0 into Algorithm 2.0 will be derived. Discussion: In Germany, there is an ongoing dynamic legislation process regarding further developing the long-term care sector. The study, which is the subject of the study protocol presented here, generates an evidence-based strategy for the staffing requirements for nursing homes. Ethics and dissemination. This study was approved by the Ethics Committee of the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft) on 02.08.2023 (amended on 20.09.2023). Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. Trial registration number: German Clinical Trails Register DRKS00031773 (Date of registration 09.11.2023). [ABSTRACT FROM AUTHOR]

In the United States, small residential care homes provide affordable community-based care for disabled older adults. Also called adult foster care homes, residential care facilities, group homes, or board and care homes, small residential care homes are typically private, small businesses operating in single-family dwellings that provide round-the-clock care in a home-like setting in residential neighborhoods. While most states license small residential care homes they also exist, legally and illegally, as unlicensed and unregulated operations. The quality of care in some unlicensed and unregulated small residential care homes can be questionable. Disabled older adults are targeted and victimized by unethical small residential care home operators for financial gain. This commentary highlights the need for whole system disruption to end victimization in unethical unlicensed and unregulated small residential care homes through case studies of the abuse and neglect of residents living in unethical unlicensed operations and recommends ambitious goals centered on reducing secondary financial gains and medically neglectful practices. These recommendations are at federal, state, and local levels, and include creating a federal definition of small residential care homes, increasing and coupling government incomes with state registration and employee misconduct registry checks, increasing oversight and assessment, improving temporary guardianship processes, providing avenues for reporting abuse, and developing older adult fatality review teams. [ABSTRACT FROM AUTHOR]

Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, there is the keeping of a complete and detailed documentation/diary of the patient, the lack of which can generate medico-legal problems. In this paper, we present three cases of guests in residences for a dependent person brought to the attention of the Institute of Forensic Medicine of the University Hospital of Palermo due to criminal proceedings, where the lack of existing documentation in the structure and, in some cases, the behavior of the professionals working there, led the evaluator to deduce the organization's culpability. [ABSTRACT FROM AUTHOR]

The article presents the discussion on COVID-19 long-term care facility shutdowns and fears escalating a trend for certified volunteer ombudsmen (CVO) resignations and retirements. Topics include ombudsmen trained in social work being a natural alliance between ombudsmen and LTC facility social workers; and loss of CVO-driven complaint data representing a critical loss of information informing systems advocacy.

The article discusses the possibilities and limitations of prohibited assisted suicide in nursing and care facilities. The Constitutional Court (VfGH) has declared one variant of "assistance in suicide" unconstitutional, which has led to a re-regulation of assisted suicide. Hospitals and care facilities can now prohibit or even prevent assisted suicide on their premises in certain situations. The article also discusses the voluntary nature of suicide support and the criminal responsibility of employees in healthcare facilities for cases of omitted suicides. It also addresses the framework for living wills and the ongoing criminalization of assisted suicide. [Extracted from the article]

Forced heirship is considered a limit on the freedom of will of the deceased in favour of intergenerational solidarity. It involves that some relatives, usually descendants, have the right to claim a share of the deceased's assets or estate. Although recognized in most EU jurisdictions, authors discuss about the need to regulate this institution taking into account new family models and societal changes. In fact, this debate has been intensified due to the COVID-19 pandemic, which showed that several elders died alone in nursing homes without family support, and part of their assets shall be reserved to their relatives. This paper analyses the legal framework of forced heirship in Spain and examines to which extent it is possible to exclude this right due to a lack of personal relationship with the beneficiaries in view of comparative models. [ABSTRACT FROM AUTHOR]

Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings.Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively.Study Design: We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally.Data Collection/extraction Methods: We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year.Principal Findings: Our team empirically documented provisions requiring dementia-specific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two.Conclusions: We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings. [ABSTRACT FROM AUTHOR]

Background/objectives: Regulatory oversight has been a central strategy to assure nursing home quality of care for decades. In response to COVID‐19, traditional elements of oversight that relate to resident care have been curtailed in favor of implementing limited infection control surveys and targeted complaint investigations. We seek to describe the state of nursing home oversight during the pandemic to facilitate a discussion of whether and how these activities should be altered going forward. Design and setting: In a retrospective study, we describe national oversight activities in January–June 2020 and compare these activities to the same time period from 2019. We also examine state‐level oversight activities during the peak months of the pandemic. Participants: United States nursing homes. Data Publicly available Quality, Certification, and Oversight Reports (QCOR) data from the Centers for Medicare and Medicaid Services (CMS). Measurements Number of standard, complaint, and onsite infection surveys, number of deficiencies from standard and complaint surveys, number of citations by deficiency tag, and number and amount of civil monetary penalties. Results: The number of standard and complaint surveys declined considerably in the second quarter of 2020 relative to the same time frame in 2019. Deficiency citations generally decreased to near zero by April 2020 with the exception of infection prevention and control deficiencies and citations for failure to report COVID‐19 data to the national health safety network. Related enforcement actions were down considerably in 2020, relative to 2019. Conclusion: In the months since COVID‐19 first impacted nursing homes, regulatory oversight efforts have fallen off considerably. While CMS implemented universal infection control surveys and targeted complaint investigations, other routine aspects of oversight dropped in light of justifiable limits on nursing home entry. Going forward, we must develop policies that allow regulators to balance the demands of the pandemic while fulfilling their responsibilities effectively. [ABSTRACT FROM AUTHOR]

The current pandemic has changed the way allied health professionals, including recreational therapists, provide care in the nursing home setting. This article aims to address concerns for older adults residing in nursing homes by reviewing the history of nursing homes, analyzing the impact regulations have had on the recreational therapy profession, and offering considerations for future practice in a COVID-19 world. [ABSTRACT FROM AUTHOR]

The article comments on the court case R. v. Barton and Booth related to dishonesty in criminal law wherein the British Court of Appeal found that the appellant, who ran a nursing home, had dishonestly targeted and befriended wealthy and childless elderly residents of the home to profit from them.

Medicaid nursing home (NH) reimbursement rates and bed-hold policies have been shown to be associated with hospitalization of urban NH residents, but their relationships with emergency department (ED) visits, especially in rural NHs, remain unknown. This study explores the relationships of Medicaid NH policies with three NH quarterly risk-adjusted rates of ED use for long-stay residents and evaluates whether the associations differed by NHs' geographical locations. Longitudinal study of Medicaid policies and NH risk-adjusted rates over 3 quarters (2011 Q3, 2012 Q3, and 2013 Q3), using Generalized Estimating Equation (GEE) models. 14,514 unique NHs. Quarterly risk-adjusted rates of any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED) were calculated from national Medicare claims and NH Minimum Data Set 3.0. Medicaid policies were consolidated from several publicly available sources. NH and market characteristics were extracted from the Certification And Survey Provider Enhanced Reporting and the Area Health Resources File. In 2012, states reimbursed NHs, on average, $162.60 per resident-day, and 36 states employed bed-hold policies. Although a $10 increase in reimbursement rates was associated with statistically significantly lower rates of any ED, outpatient ED, and PAED in both urban and micropolitan NHs (−0.79%, −1.09%, and −1.02% for urban NHs; −1.29%, −1.90%, and −3.22% for micropolitan NHs, respectively), it was not associated with any ED measure in rural NHs. Medicaid bed-hold polices were associated with about 9% to 12% lower rates of all types of ED visits in urban NHs, but were not related to any of the ED measures in micropolitan and rural NHs. Associations of Medicaid NH policies with ED utilization are weaker in rural NHs than urban NHs. Yet, the financial viability of increasing Medicaid reimbursement to reduce the ED use may not be cost-effective. [ABSTRACT FROM AUTHOR]

In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home (NH) quality assurance system. This study examines trends in facility, resident, and quality characteristics since passage of that legislation. We conducted univariate analyses of national data on US NHs from 3 sources: (1) the 1985 National Nursing Home Survey (NNHS), (2) the 1992-2015 Online Survey Certification and Reporting (OSCAR) Data, and (3) LTCfocUS data for 2000-2015. We examined changes in NH characteristics, resident composition, and quality. US NH facilities and residents between 1985 and 2015. The proportion of NHs that are Medicare and Medicaid certified, members of chains, and operating not-for-profit has increased over the past 30 years. There have also been reductions in occupancy and increases in the share of residents who are racial or ethnic minorities, admitted for post-acute care, in need of physical assistance with daily activities, primarily supported by Medicare, and diagnosed with a psychiatric condition such as schizophrenia. With regard to NH quality, direct care staffing levels have increased. The proportion of residents physically restrained has decreased dramatically, coupled with changes in inappropriate antipsychotic (chemical restraint) use. Together with changes in the long-term care market, the NHs of today look very different from NHs 30 years ago. The 30th anniversary of OBRA provides a unique opportunity to reflect, consider what we have learned, and think about the future of this and other sectors of long-term care. [ABSTRACT FROM AUTHOR]

Improving nursing home care has been a central legislative focus since the 1980s; The major response effort to address these reports of poor-quality care was first met with a federal rule in 1987, the Nursing Home Reform Act (NHRA). Since enactment of the NHRA in 1987, and despite an increasing utilization of nursing home care by aging minorities, the standardization of care practice, or quality indicators (e.g., structural, process, and outcome measures), within long-term nursing home care have remained relatively unchanged. This paper reports a value-critical policy analysis of the most recent final action rule, effective on November 28 of 2016 by the Centers for Medicare and Medicaid Services (CMS) with a particular focus on its impact on African-American and Latino older adults. This paper presents results of two policy analyses. Taken together, this merged analysis focuses on an overview of the problem, the groups most affected by the problem, current program goals and objectives, forms of benefits and services, and a current state of the social problem. Following the analysis, we present changes and improvements to be made, as well as proposals for reform and recommendations for policy changes. [ABSTRACT FROM AUTHOR]

Currently, there is a circuit split between the Ninth and Eleventh Circuits regarding whether bankruptcy courts have jurisdiction over a Medicare or Medicaid dispute under Title 42, § 405(h) of the U.S. Code. If the bankruptcy court does not have jurisdiction over a Medicare provider agreement dispute, as the Eleventh Circuit recently held in In re Bayou Shores SNF, the nursing facility is effectively unable to bring its case before the bankruptcy court and potentially denied an opportunity to reorganize. This Note analyzes the practical effects of the Eleventh Circuit's In re Bayou Shores SNF decision by considering statistics on rising Medicare costs, projected elderly population growth, increase in the number of people expected to use long-term care, and a recent increase in nursing home Chapter 11 filings. Additionally, this Note examines the potential reorganization hurdles nursing facility debtors may face if their Medicare claims are adjudicated through the HHS's review process. This Note further argues that In re Bayou Shores SNF is contradictory to many of the congressional policies of bankruptcy law. Lastly, this Note recommends that because the Supreme Court has denied certiorari to resolve the circuit split, bankruptcy courts should exercise jurisdiction over Medicare disputes under 42 U.S.C. § 405(h)--while using discretionary factors to abstain from hearing especially complex Medicare issues. This recommendation places an emphasis on the congressional-endorsed objective of providing an expeditious and efficient bankruptcy process for the debtor, while balancing the interests of the Department of Health and Human Services to process complicated Medicare disputes. [ABSTRACT FROM AUTHOR]

The Centers for Medicare and Medicaid Services (CMS) finalized a comprehensive update to nursing home requirements of participation in October 2016. Nearly 10,000 public comments were received regarding the proposed rule, and CMS made multiple modifications based on comments from providers, advocacy organizations, and others before issuing the final rule. The final rule describing nursing home requirements of participation modernizes nursing home regulation. It is being implemented in three phases—beginning in November 2016, November 2017, and November 2019. There are multiple provisions that have implications for clinicians caring for nursing home residents, particularly in terms of management of infections, medication prescribing and monitoring, and delegation of medical orders. [ABSTRACT FROM AUTHOR]

The regulation of nursing homes in the U.S. often includes mandates that require a minimum nurse staffing level. In this paper, we exploit new minimum nurse staffing regulations by the states of New Mexico and Vermont that were implemented in the early 2000s to determine how nursing homes responded in terms of staffing, quality, and the decision to exit the market. Our identification strategy exploits the fact that some nursing homes had pre-regulatory staffing levels near the new requirement and did not need to change staffing levels. We compare these nursing homes to a group that faced binding constraints (low-staffed) and those that were significantly over the constraint (high-staffed). Low-staffed nursing homes increase staffing levels but also use less expensive nurse types to satisfy the new standard. High-staffed nursing homes decrease staffing and use fewer contracted staff. Overall, dispersion in staffing is reduced, but we find little effect by pre-regulatory staffing level on non-staffing measures of quality and the decision to exit the market. [ABSTRACT FROM AUTHOR]

Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes. [ABSTRACT FROM AUTHOR]

Background: Although many countries have implemented strict legal rules, the prevalence of physical restraints in nursing homes seems to remain high. In Switzerland, data related to the frequency of physical restraints are scarce and little is known about associations with resident and nursing home characteristics. The aim of this study was to investigate the prevalence and types of physical restraints in nursing homes in two Swiss cantons and to explore whether resident-related and organisational factors are associated with the use of physical restraints.Methods: We conducted a multicentre cross-sectional study. Twenty nursing homes with 1362 residents from two culturally different cantons were included. Data on physical restraints and residents' characteristics were extracted from residents' records (11/2013 to 2/2014). Organisational data were collected by questionnaires addressing nursing home directors or nursing managers. Sample size calculation and outcome analysis took cluster-adjustment into account. Descriptive statistics and multiple logistic regression analysis with nursing homes as random effect were used for investigation.Results: The prevalence of residents with at least one physical restraint was 26.8 % (95 % confidence interval [CI] 19.8-33.8). Centre prevalence ranged from 2.6 to 61.2 %. Bilateral bedrails were most frequently used (20.3 %, 95 % CI 13.5-27.1). Length of residence, degrees of care dependency and mobility limitation were significantly positively associated with the use of physical restraint, but none of the organisational characteristics was significantly associated.Conclusion: Approximately a quarter of the nursing home residents included in our study experienced physical restraints. Since variation between nursing homes was pronounced, it seems to be worthwhile to explore nursing homes with particularly low and high use of physical restraints in future research, especially by using qualitative methods. There is a need for effective interventions aiming at restraint-free nursing care. Development of interventional approaches should consider specific residents' characteristics associated with restraint use. [ABSTRACT FROM AUTHOR]

The article explores issues regarding pre-dispute arbitration clauses in nursing homes, focusing on residents' legal rights and public policy matters in the U.S., as of October 2016. Topics discussed include enactment of the Federal Arbitration Act; laws related to arbitration in nursing home admission contracts; and laws related to judicial review of arbitration decisions.

The article discusses two court cases on the legitimacy of voluntarily stopping eating and drinking (VSED) in British Columbia. Among the case discussed include Bentley v. Maplewood Seniors Care Society in 2014 and Bentley v. Maplewood Seniors Care Society in 2015. The background, lower court decision, and Court of Appeal decision about the two cases are also discussed.

Continued growth in the number of individuals with dementia residing in assisted living (AL) raises concerns about their safety and protection. In this Forum, we review current AL practices relevant to residents with dementia and present a rationale for examining the government role in protecting these individuals within this context. Since public oversight of AL is currently a state prerogative, we assess states' regulatory activity across 3 domains closely related to safety and protection of persons with dementia: environmental features, staffing, and use of chemical restraints. We then step back to consider the state policymaking environment and assess the feasibility of developing a minimum standard of regulations from one state to the next. This Forum concludes with a historical comparison between the contemporary AL market and the nursing home care market prior to the Nursing Home Reform Act of 1987, and we discuss how an increased amount of federal interest could improve existing state efforts to protect persons with dementia residing in AL. [ABSTRACT FROM AUTHOR]

Understanding the role of competition in determining prices and quality is important in evaluating various public policies, including any antitrust investigation of a proposed merger. This is especially true in health-care markets where consumers are less informed than providers and standard mechanisms such as warranties cannot protect consumers against inferior products. This article examines how market structure affects the quality of care provided in a health-care market by examining the nursing home industry. We empirically test if quality is affected by a change in market structure that arises when a competitor exits the market. Using a sample of rural nursing homes that have a competitor exit and also experience no entry from new competitors, the effect of market structure is identified using a difference-in-differences approach that compares facilities that are within the same geographic market as the exiting facility to a group of facilities outside that geographic market. We find that total staffing levels are lower after the closure after adjusting for transitory effects. All non-staffing quality measures show improvement after the closure, although not all are found to be statistically significant. This suggests supracompetitive markets with excess capacity may actually have lower levels of quality than more concentrated markets. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives We examined the effect of two interventions on both the reliability and validity of regulatory judgments: adjusting the regulatory instrument and attending a consensus meeting. Method We adjusted the regulatory instrument. With a randomized controlled trial ( RCT) we examined the effect of the adjustments we made to the instrument. In the consensus meeting inspectors discussed cases and had to reach consensus about the order of the cases. We used a before and after case study to assess the effect of the consensus meeting. We compared the judgments assigned in the RCT with the unadjusted instrument with the judgments assigned with the unadjusted instrument after the consensus meeting. Moreover we explored the effect of increasing the number of inspectors per regulatory visit based on the estimates of the two interventions. Results The consensus meeting improved the agreement between inspectors; the variance between inspectors was smallest (0.03) and the reliability coefficient was highest (0.59). Validity is assessed by examining the relation between the assigned judgments and the corporate standard and expressed by a correlation coefficient. This coefficient was highest after the consensus meeting (0.48). Adjustment of the instrument did not increase reliability and validity coefficients. Conclusions Participating in a consensus meeting improved reliability and validity. Increasing the number of inspectors resulted in both higher reliability and validity values. Organizing consensus meetings and increasing the number of inspectors per regulatory visit seem to be valuable interventions for improving regulatory judgments. [ABSTRACT FROM AUTHOR]

This article examines the effects of state regulation and civil class action litigation on corporate compliance with nurse staffing and quality standards, corporate strategies to manage staffing and quality, and corporate financial status of a large for-profit nursing home chain. A historical case study was used to examine multiple public data sources, focusing on facilities in California from 2003 to 2011 during and after regulatory actions and litigation. The results showed that the state issued numerous deficiencies for violations of the nurse staffing and quality standards with minimal impact on quality compliance with state law. A class action jury trial found that the chain violated the state’s minimum staffing standard on one-third of the total days during a six-year period and awarded a $677 million verdict. A court settlement and supervised injunction resulted in compliance with minimum staffing and some improvement in quality measures, but quality levels remained below the average California facilities. The litigation also had some negative financial impact on Skilled Healthcare Group’s California facilities and parent company. Civil litigation had more impact on the chain than the regulatory oversight. [ABSTRACT FROM AUTHOR]

The article discusses why Kentucky should adopt a narrow approach regarding a quality assurance privilege in nursing home litigation, and it mentions how nursing home documents that are determined to have been created as part of an effort to improve the quality of resident care at a nursing home facility will be undiscoverable during litigation. Judge-made law (case law) in Kentucky is mentioned, along the legal rights of nursing home patients and the U.S. Federal Nursing Home Reform Act.

Dr. Sidney Katz’s legacy to the field of gerontology is internationally recognized as his success at developing standardized measures and processes, beginning with the activities of daily living index, for the functional assessment of older adults with chronic conditions necessitating long-term services and supports. That work served as the bedrock for his subsequent major accomplishments, which improved rehabilitation services through interdisciplinary team work and attention to the patient-family constellation; reformed the regulation of nursing homes, refocusing it on resident outcomes and quality of life; and promulgated the concept of active life expectancy as a new approach to measuring the quality of later life. Few other scholars and researchers in the history of the field of aging can claim one, much less multiple monumental contributions leading to major advances in the treatment of chronic illness and the quality of long-term care. [ABSTRACT FROM PUBLISHER]

The article discusses the reform to the medicare coverage three-day qualifying stay rule for skilled nursing facility (SNF) care by the Centers for Medicare and Medicaid Services (CMS) of the U.S. It informs that these changes enhanced the working standards of the SNF care for advanced medical treatment to the elder people of the U.S. It mentions that the American Medical Association (AMA) also contributed to the changes in the SNF care.

The article examines the Pre-Admission Screening and Annual Resident Review (PASRR) process. It is noted that U.S. states are required to implement the PASRR under the Nursing Home Reform Act (NHRA). The article also assesses the effectiveness of the PASRR and describes the current condition of nursing facility residents as of July 2013.

Context: Although observers have long highlighted the relationship of public distrust, government regulation, and media depictions of nursing-home scandals, no study has systematically analyzed the way in which nursing homes have been portrayed in the national media. This study examines how nursing homes were depicted in four leading national newspapers-the New York Times, Washington Post, Chicago Tribune, and Los Angeles Times-from 1999 to 2008. Methods: We used keyword searches of the LexisNexis database to identify 1,704 articles pertaining to nursing homes. We then analyzed the content of each article and assessed its tone, themes, prominence, and central actor. We used basic frequencies and descriptive statistics to examine the articles' content, both cross-sectionally and over time. Findings: Approximately one-third of the articles were published in 1999/2000, and a comparatively high percentage (12.4%) appeared in 2005. Most were news stories (89.8%), and about one-quarter were on the front page of the newspaper or section. Most focused on government (42.3%) or industry (39.2%) interests, with very few on residents/family (13.3%) and community (5.3%) concerns. Most were negative (45.1%) or neutral (37.0%) in tone, and very few were positive (9.6%) or mixed (8.3%). Common themes were quality (57.0%), financing (33.4%), and negligence/fraud (28.1%). Both tone and themes varied across newspapers and years. Conclusions: Overall, our findings highlight the longitudinal variation in the four widely read newspapers' framing of nursing-home coverage, regarding not only tone but also shifts in media attention from one aspect of this complex policy area to another. The predominantly negative media reports contribute to the poor public opinion of nursing homes and, in turn, of the people who live and work in them. These reports also place nursing homes at a competitive disadvantage and may pose challenges to health delivery reform, including care integration across settings. [ABSTRACT FROM AUTHOR]

The article discusses a court case of Marmet Health Care Center v. Brown related to the approval of arbitration agreements used for avoiding or minimizing the accountability of the negligence made by nursing homes, as stated by the U.S. Supreme Court. The use of mandatory pre-dispute arbitration agreements by the vulnerable population is discussed. The challenges faced due to the federal law, the Federal Arbitration Act, which offers protection to the nursing homes from judicial accountability in case of their ignorance of quality of care standards are also discussed.

Objective. To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources. U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design. Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method. Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings. The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions. MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality. [ABSTRACT FROM AUTHOR]

The article offers information about changes to elder law through legislation and actions in Illinois in 2011. Examples of legal developments include the court case In re Estate of Michalak, Public Act 96-0980 that amended the Trusts and Trustees Act, and the passage of the Public Act 96-1372 Nursing Home Safety Bill.

This study draws on pertinent literature that includes theories of public administration relating to federalism, intergovernmental relations, and the role of public administrators in the policymaking process, to systematically assess the influence of political factors, oversight, and affiliation/ownership status of nursing facilities on the nursing home regulatory regime inaugurated by the Nursing Home Reform Act of 1987 and its progeny. Specifically, it measures, using regression analysis, variables that account for variations nationwide in the citation of deficiencies for violation of nursing home regulations. Previous studies have speculated on the possible influence of political considerations in citation of deficiencies across states. Our study takes the scholarship one level higher by actually testing the influence of political and other factors on the citation of deficiencies by state inspectors. Our efforts yielded several fruitful findings: (1) we are able to confirm definitively that political factors play an important role in the differences observed across the states in the citation of deficiencies by inspectors; (2) some of our findings are statistically significant, although those findings also uncovered a puzzling result regarding for-profit chains that we attribute to underreporting of deficiencies; and (3) our independent variables accounted for nearly 52 percent of the variance in our dependent variable, a figure deemed respectably high in social science research. [ABSTRACT FROM AUTHOR]

The article discusses regulations for nursing care facilities provided by the Affordable Care Act (ACA) in the U.S. Transparency and accountability are promoted by several reforms such as reporting governance and staffing information, standardized complaint resolution procedures, and making investigative reports available to the public. Consumer-oriented web sites must be maintained by states to assist the Nursing Home Care web site of the Department of Health and Human Services (HHS) in the evaluation of facilities. Background checks on prospective direct patient access employees must be conducted by the nationwide program of the HHS.

This report examines the impact of a 2004 law in Poland intended to substitute medically-oriented, central government-funded institutional long-term care with social care-oriented welfare homes, market alternatives and increased informal and community-based alternatives. Data were extracted from recently published reports, government statistics and a survey of 69 social care homes in Poland. The results indicate the continued dominance of hospital-based long-term care, the lack of shift to social care provision, the anemic growth of privatization and the dearth of informal and community-based care. The 2004 law was insufficient in shifting the burden of long-term care from the national health insurance fund to local municipalities, the social assistance sector and consumers. [ABSTRACT FROM AUTHOR]

The article explains the role of Medicaid in the U.S. to resolve racial inequities in the health care system. A study revealed that African Americans in nursing homes were four times as likely to suffer in a home with limited resources and historically poor performance compared to Caucasian patients. A discussion on the enforcement of Title VI by African Americans to rectify racial inequities is presented. Meanwhile, compliance with the Medicaid Act and the Nursing Home Reform Act (NHRA) to address unequal quality of care is suggested.

The article discusses several court cases about the U.S. Nursing Home Act. The appellate court concluded that common-law punitive damages are not available in a survival action brought under the Nursing Home Act because there is no statutory basis for punitive damages in the case Vincent v. Alden-Park Strathmoor Inc. It also discusses the Illinois Supreme Court decision to reject an argument that common-law punitive damages may be recoverable under the Survival Act in Mattyasovszky v. West Towns Bus Co.