Navigation Links
2004 long-term care act raised costs and worsened care, study shows
Date:4/8/2008

The California Long-Term Care Reimbursement Act of 2004 increased nursing home costs, but failed to improve quality or access to care, according to a UCSF evaluation on the legislations impact.

Between 2004 and 2006, MediCal costs in Californias free-standing nursing homes increased by $590 million, or nearly 9 percent, to a total of $6.6 billion in 2006, according to the study, which was released today by researchers in the UCSF School of Nursing. Yet during the same time period, nursing home staffing levels remained significantly lower than the recommended numbers and staff turnover actually increased.

The study used publically available federal and state data to provide an initial evaluation of the impact of the new rate system. Among the elements analyzed were MediCal admissions and length of care; staffing levels, staff turnover, complaints and citations; and nursing home profits and income margins.

The quality of nursing home care has been a serious problem in California and nationwide for many years, said Charlene Harrington, PhD, RN, UCSF professor of sociology and nursing and lead author of the study. This legislation was designed to address that, but so far it has not met the challenge.

Harrington said the bill was designed to improve both the quality and access to nursing home care by increasing MediCal reimbursement rates, using a payment system based on actual costs of care for each facility, with certain cost ceilings. It also aimed to increase nurse staffing levels, foster improved compliance with state and federal regulations, and improve efficiency in nursing home administration.

Implemented in 2004-05, the system effectively raised MediCal rates from $124 per day in 2004 to $152 per day in 2006, this analysis found.

However, that rise did not result in improved access to nursing homes; the total number of patient days billed to MediCal actually decreased 2 percent between 2004 and 2005, while the overall proportion of MediCal days remained steady at 69 percent of the total patient-days of care statewide.

The evaluation did show a slight increase in overall nursing home staffing levels statewide by 2006, Harrington said, but staffing by registered nurses remained significantly lower that those recommended by experts. In fact, 16 percent of the facilities, or 144 total, still failed to comply with the minimum state staffing standard, which is 3.2 RN hours per resident-day.

Harringtons previous research has established a direct correlation between the number of registered nurses on staff in nursing homes and the quality of patient care.

Under the current legislation, nursing staff turnover grew worse in nursing facilities and was unacceptably high in all types of facilities analyzed, with three out of four staff members leaving employment each year. Wages and benefits for nursing assistants, who provide the majority of nursing home care, also did not keep pace with inflation between 2004 and 2006, but administrative salaries were increased substantially.

The assessment concluded that the quality of care after the implementation of the new reimbursement rate system actually appeared to decline. During that time, the number of complaints about poor quality of care increased, as did documented deficiencies and citations, including those that caused harm and jeopardy.

Nursing assistant wages failed to keep pace with inflation between 2004 and 2006 and licensed nursing inflation-adjusted wage increases were minimal, while staff benefits declined. Overall, the new reimbursement rate increased the net income margins in all types of nursing facilities by over 700 percent.

With increased revenues, spending on direct care was expected to increase, according to the studys authors, and did rise 13 percent in the two years analyzed, due to a modest (3 percent) increase in total staffing. Administrative expenditures, however, rose 19 percent in the same time period, reflecting the new quality assurance fee costs, licensing fees, training costs, and liability costs. As a result, the level of direct care spending dropped in proportion to the total costs, to 53 percent after the new reimbursement system was implemented.

Clearly, California needs to seriously address the policy changes in reimbursement rates that are needed to achieve these goals in quality of care, Harrington said.

The studys authors made four recommendations to achieve those goals:

  • Attach more specific minimum requirements for staffing levels.
  • Establish greater penalties for poor quality of care, including zero tolerance for not meeting minimum staffing levels.
  • Stronger enforcement of the staffing standards and quality standards.
  • Substantially increase wages and benefits for nursing staff to reduce turnover and stabilize the workforce.


'/>"/>

Contact: Kristen Bole
kbole@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
Source:Eurekalert

Related medicine news :

1. Childhood Leukemia Survivors Struggle With Long-Term Comorbidities
2. Spirit II explores long-term performance of XIENCE V stent
3. Governor Rendell Announces Own Your Future Campaign; Urges Consumers to Better Plan Their Long-Term Care Needs
4. Long-Term Data for 884 Patients Show Vertebroplasty for Osteoporotic Spinal Fractures Provides Dramatic Pain Relief, Greatly Decreases Disability
5. Study Analyzed Long-Term SYMBICORT(R) Use in Children With Persistent Asthma
6. A long-term survival offered by resection of solid-pseudopapillary tumor of the pancreas?
7. Controversial shoulder surgery for first-time dislocation proven effective long-term
8. WHI follow-up study: Risks of long-term hormone therapy continue to outweigh benefits
9. Crdentia Announces Completion of $10.2 Million Long-Term Debt Financing
10. Foundation Radiology Group and Brownsville Tri-County Hospital Sign Long-Term Contract for Diagnostic Imaging Services
11. HIV persists in the gut despite long-term HIV therapy
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/5/2016)... Francisco, CA (PRWEB) , ... ... ... intensive lectures and hands-on exercises, the Wharton Seminars for Business Journalists ... a better understanding of key business and economic issues.  This one-day program ...
(Date:5/5/2016)... ... May 05, 2016 , ... Every ... the most heartfelt wishes of these children. The wishes provide hope and ... President and CEO of Make-A-Wish Mississippi, Brent Wilson said, “In 2016, the organization ...
(Date:5/5/2016)... ... ... A recent survey by the Midwest Business Group on Health ... use the free preventive care benefits available to them as part of the Affordable ... public and private employers, MBGH found that only 10% of large employers are aware ...
(Date:5/5/2016)... , ... May 05, 2016 , ... ... Pittsburgh-area schoolchildren has found that more than 40 percent of participating fifth-grade students ... , Director of Allergy and Asthma Clinical Research in the Division of Pulmonary, ...
(Date:5/5/2016)... ... May 05, 2016 , ... ... presented a talk highlighting the organization’s successful Care Transitions program at ... The talk was titled “Minimizing Costs in the Post-Acute Environment Through Effective Transitions ...
Breaking Medicine News(10 mins):
(Date:5/3/2016)... COLOGNE, Germany , May 3, 2016  Axiogenesis has acquired a major investment from Sino-German High-Tech Fund to ... http://photos.prnewswire.com/prnh/20160503/362920    Photo - http://photos.prnewswire.com/prnh/20160503/362921 ... ... ... ...
(Date:5/3/2016)... ACME Markets, Delaware County ... County Councilman Dave White announced today the ... ACME pharmacies across Delaware County . ... naloxone has saved 26,463 lives nationwide over the past 20 years. ... were authorized to administer naloxone to overdose victims, 244 ...
(Date:5/3/2016)...  While you may be familiar with watching a film or TV show in high definition, ... 8MP in the Medical Industry.  Ampronix  is a renowned authorized reseller of the medical industry,s ... - http://photos.prnewswire.com/prnh/20160502/362730 ... ... ...
Breaking Medicine Technology: