Understanding the Role of Nursing Home Enforcement and Oversight in Post-Acute and Long-Stay Resident Quality of Care

About This Grant

PROJECT SUMMARY/ABSTRACT This mixed-methods study aims to examine the effectiveness of Civil Monetary Penalties (CMPs) in enhancing care quality within nursing homes. The study focuses on determining whether CMPs serve as effective deterrents against substandard care or if they inadvertently exacerbate existing care deficiencies by imposing financial strains on facilities. Utilizing a comprehensive dataset encompassing nursing home resident claims data from 2011 to 2024, which includes detailed facility information and enforcement actions from the ASPEN/CASPER administrative data sets, this project will analyze the impacts of CMPs on nursing home care outcomes. Aim 1 of the project will explore the relationship between CMPs and the incidence of nursing home deficiencies, considering certain resident, facility, operational, and external factors that may influence the magnitude and frequency of CMPs. Aim 2 will employ a difference-in- differences analytical approach to assess the direct impacts of CMPs on quality of care by comparing outcomes before and after penalties are imposed in facilities relative to comparison facilities with no penalties over the same period. This aim will provide a clearer picture of the causal effects of CMPs on resident care quality. Aim 3 will involve conducting in-depth qualitative interviews with state surveyors and nursing home administrators to capture insights into the variability of CMP implementation and its perceived effectiveness across different states. This aim seeks to understand the on-the-ground challenges and operational perspectives regarding CMP enforcement. We will integrate findings across Aims using a concurrent-embedded approach. The comprehensive approach of this study is expected to yield valuable empirical evidence that will inform policymakers and help refine regulatory practices to ensure that CMPs are applied effectively and fairly. By assessing whether CMPs enhance care quality without unintended negative consequences, this research supports the broader goal of improving elder care across the United States.