The relationship between nursing home expenses and superiority of care. When individuals need long-term services for themselves, or family members, because they can no long manage at home, they are demanding that the necessary nursing home care be available, and that the care be good superiority. Consumers are also demanding mechanisms that will allow them to evaluate the superiority of care provided in nursing homes. In addition to consumers, policymakers, who are responsible for oversight of the public funding of more than 70% of patient days in nursing home care and approximately two-thirds of expenditures on nursing home care, want assurance that monies are contributing to better superiority care (Grabowski & Hirth, 2003; Levit et al., 2003).

The inadequacy of the superiority of care delivered in nursing homes has long been an issue. Following a 1986 Institute of Medicine report on prevalent problems with the superiority of care in nursing homes (IOM, 1986), a number of laws, regulations, and efforts have been introduced to address the problems. Despite improvements in a number of areas, problems with superiority of care continue to persist, as evidenced by an increase in 13 of 25 superiority of care deficiencies and an increase in ombudsman complaints in recent years (Office of Inspector General, 1999). Also, a recent study found that over 25% of nursing homes "had potentially life threatening problems in delivering care and were harming residents" (Harrington, 2001, p. 507).

A common perception is that higher superiority is associated with higher expenses. If this is found to be true, then improving superiority in nursing homes will face substantial obstacles, especially in these times of state budget deficits and the federal proposals to convert Medicaid funding to block grants (U.S. Department of Health and Human Services, 2003). Since Medicaid is a major funding source for nursing homes, paying over 50% in 2002 (Levit et al., 2003), if there is a direct relationship between expenses and superiority, then efforts to improve superiority in nursing homes may be increasingly difficult.

Record Number: A320732785