Harrington Book

Nursing Facilities, Staffing, Residents and Facility Deficiencies,
2000 Through 2006

This book, by Charlene Harrington, Helen Carillo, and Brandee Woleslagle Blank, was published in September 2007.  The entire book including its text, tables and graphs, appears here in sections.  It shows trends in U.S. nursing homes by state from 2000 through 2007.  The data are from the federal On-Line Survey and Certification System (OSCAR) reports that are completed at the time of the annual nursing home surveys by state Licensing and Certification programs for the U.S.Centers for Medicare and Medicaid Services. You may retrieve and print the book by clicking on each link below.  The documents are in pdf format and may take a moment to download.  You will need Acrobat Reader to open the documents. 

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Highlights from this year's report can be found in the press release. Some findings follow below:

• The number of nursing homes operated by hospitals declined by 29 percent (from 12 to 8.6 percent) of total homes. These hospital-based facilities are nursing homes that had the highest staffing and the most Medicare residents.
• Nursing home occupancy rates declined from 86 percent to 85 percent, at a time when the population is aging.
• The average number of registered nurse (RNs) hours per resident day declined by 25 percent between 1998 and 2000 and by 14 between 2000 and 2006. The number of nursing assistants (NAs) increased to make up for the reduction in registered nurse hours. This shows a dramatic decline in the skills and training of staff since the implementation of the Medicare prospective payment system in 1998. Studies have shown facilities with more RN staffing have higher quality of care on average.
• The percent of residents with dementia increased by 6 percent and the percent with other psychiatric diagnoses increased by 33 percent (from 15.4 to 20.5 percent of residents). The number of residents needing psychological and behavioral management is increasing.
• The average number of deficiencies increased from 5 in 2000 to 9.2 per facility in 2004 and then declined to 7.5 in 2006. Either quality improved slightly or, more likely, regulatory oversight is declining.
• At the same time, the percent of facilities receiving serious deficiencies for causing harm or jeopardy declined by almost 23 percent (from 23.5 percent in 2000 to 18.1 percent in 2006). This suggests that quality is either improving or states are less likely to give serious deficiencies. These is little evidence of improved quality so it is more likely that a change in the survey ratings of deficiencies has occurred.

The author notes that these trends in nursing homes should be of concern to policy makers, nursing home providers, and consumer advocates because they do not show major improvements over the past seven years. Moreover, they show continued wide variations in staffing, residents, quality of care and enforcement across states.