Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Nursing home quality has been an issue of interest to policymakers for decades. As the role of nursing homes continues to evolve, predictors of quality and the appropriate measurement of quality continue to be analyzed and debated by researchers. The most common data sources for the construction of quality indicators are data from the Centers for Medicare and Medicaid Services. These include information from the survey and certification process (including some complaint data) and patient level measures from the Minimum Data Set, both of which are generated from state certification agencies and the nursing home facilities themselves. One potentially important source of quality information that has been underutilized by researchers is data from the Long Term Care (LTC) Ombudsman Program. The LTC Ombudsman Program was established through the Older Americans Act to advocate on behalf of the long term care residents. Part of this advocacy is to receive, investigate and mediate complaints about nursing homes from facility residents, their families, and nursing home staff. While the general public often calls upon the LTC Ombudsman Program, using the program's complaint information when choosing a long term care facility for a family member, little research has been done on the determinants of these complaints. Given that complaints to the LTC Ombudsman may capture a different dimension of quality than traditional CMS-derived measures, this work seeks to determine whether the traditional predictors of nursing home quality are similarly associated with Long Term Care Ombudsman Program complaints.

Using quarterly complaint data from the North Carolina Long Term Care Ombudsman Program for 2003 - 2006, the complaints in a quarter will be modeled as a function of traditional predictors of nursing home quality: resident case mix, location-specific attributes, facility for-profit/not-for-profit status, proportion of Medicaid recipients within a facility, corporate/chain membership, market concentration and facility size. Traditional predictors of quality will be analyzed to determine whether they are associated with LTC Ombudsman Program complaints or whether there appear to be different factors that predict consumer driven LTC Ombudsman Program complaints. These findings may shed light on characteristics of nursing home care that predict consumer complaints to the LTC Ombudsman Program, where policymakers may choose to focus regulatory attention on homes with characteristics that are correlated with these types of complaints.