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Article ; Online: Improving the Fate of Nursing Homes During the COVID-19 Pandemic: The Need for Policy.

Konetzka, R Tamara

2021 Volume 111, Issue 4, Page(s) 632–634

MeSH term(s)	Aged ; COVID-19/mortality ; COVID-19 Testing ; Humans ; Infection Control/standards ; Nursing Homes/statistics & numerical data ; Personal Protective Equipment ; Policy ; Quality of Health Care/standards
Language	English
Publishing date	2021-01-28
Publishing country	United States
Document type	Editorial
ZDB-ID	121100-6
ISSN	1541-0048 ; 0090-0036 ; 0002-9572
ISSN (online)	1541-0048
ISSN	0090-0036 ; 0002-9572
DOI	10.2105/AJPH.2020.306107
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Article ; Online: The Challenges of Improving Nursing Home Quality.

Konetzka, R Tamara

JAMA network open

2020 Volume 3, Issue 1, Page(s) e1920231

MeSH term(s)	Attitude of Health Personnel ; Clinical Competence/standards ; Home Care Services/standards ; Humans ; Leadership ; Long-Term Care/standards ; Nursing Homes/standards ; Patient Safety/standards ; Quality Improvement/standards
Language	English
Publishing date	2020-01-03
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2019.20231
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Article ; Online: The relationship between Medicaid policy and realized access to home- and community-based services.

Konetzka, R Tamara / Ellis, Emily / Ghazali, Nadia / Wang, Sijiu

Home health care services quarterly

2024 Volume 43, Issue 2, Page(s) 154–172

Abstract: Medicaid funding for home- and community-based services (HCBS) has increased substantially in recent decades. Prior research has investigated the effects of this expansion on outcomes for individuals as well as costs to Medicaid, often using state policy ...

Abstract	Medicaid funding for home- and community-based services (HCBS) has increased substantially in recent decades. Prior research has investigated the effects of this expansion on outcomes for individuals as well as costs to Medicaid, often using state policy as a proxy for access to HCBS or implicitly assuming that more generous policies affect outcomes through access, an assumption that may not hold. In this study, using survey data linked to Medicaid claims, we assess the extent to which common measures of state Medicaid HCBS generosity correspond to increased individual use of HCBS among older adults with potential needs. We find several measures to have strong predictive power, but only with relatively large changes in policy generosity. Our findings imply that increased funding of HCBS is not sufficient to ensure access to services and that researchers should be careful when using state policy generosity as a proxy for access.
MeSH term(s)	United States ; Humans ; Aged ; Medicaid ; Community Health Services ; Home Care Services ; Policy ; Surveys and Questionnaires
Language	English
Publishing date	2024-01-07
Publishing country	England
Document type	Journal Article
ZDB-ID	604604-6
ISSN	1545-0856 ; 0162-1424
ISSN (online)	1545-0856
ISSN	0162-1424
DOI	10.1080/01621424.2023.2300672
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Article ; Online: Beyond Compliance: A More Integrated Public Health Approach To Outbreaks In Nursing Homes And Other Disasters.

Wasserman, Michael / Konetzka, R Tamara

Health affairs (Project Hope)

2022 Volume 41, Issue 6, Page(s) 831–837

Abstract: Nursing home residents are vulnerable to disproportionate harm during disasters and health emergencies, as evidenced by the recent impact of COVID-19 and extreme weather events. Evaluation of these disasters shows that the nursing homes in question were ... ...

Abstract	Nursing home residents are vulnerable to disproportionate harm during disasters and health emergencies, as evidenced by the recent impact of COVID-19 and extreme weather events. Evaluation of these disasters shows that the nursing homes in question were often in compliance with relevant regulations around emergency planning. However, advance planning for disasters cannot anticipate every contingency, leading to the need for flexibility and quick adaptation on the part of nursing home leaders. In addition, disasters often involve larger, regional problems and situations that individual providers cannot solve. We suggest that policy makers need to prioritize development and expectations around leadership skills in nursing home management and better integrate the long-term care sector into local, state, and federal public health planning for future pandemics and other disasters.
MeSH term(s)	COVID-19 ; Disasters ; Humans ; Nursing Homes ; Pandemics ; Public Health
Language	English
Publishing date	2022-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2021.01839
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Article ; Online: Association of COVID-19 Vaccination Rates of Staff and COVID-19 Illness and Death Among Residents and Staff in US Nursing Homes.

Sinha, Soham / Konetzka, R Tamara

JAMA network open

2022 Volume 5, Issue 12, Page(s) e2249002

Abstract: Importance: It is important to understand the association between staff vaccination rates and adverse COVID-19 outcomes in nursing homes.: Objective: To assess the extent to which staff vaccination was associated with preventing COVID-19 cases and ... ...

Abstract	Importance: It is important to understand the association between staff vaccination rates and adverse COVID-19 outcomes in nursing homes. Objective: To assess the extent to which staff vaccination was associated with preventing COVID-19 cases and deaths among residents and staff in nursing homes. Design, setting, and participants: This longitudinal cohort study used data on COVID-19 outcomes in Medicare- and Medicaid-certified nursing homes in the US between May 30, 2021, and January 30, 2022. Participants included the residents of 15 042 US nursing homes that reported COVID-19 data to the Centers for Disease Control and Prevention and passed Centers for Medicare & Medicaid Services data quality checks in the National Healthcare Safety Network. Exposures: Weekly staff vaccination rates. Main outcomes and measures: Main outcomes are weekly COVID-19 cases and deaths among residents and weekly COVID-19 cases among staff. The treatment variable is the primary 2-dose staff vaccination rate in each facility each week. Results: In the primary analysis of 15 042 nursing homes before the Omicron variant wave (May 30 to December 5, 2021) using fixed effects of facility and week, increasing weekly staff vaccination rates by 10 percentage points was associated with 0.13 (95% CI, -0.20 to -0.10) fewer weekly COVID-19 cases per 1000 residents, 0.02 (95% CI, -0.03 to -0.01) fewer weekly COVID-19 deaths per 1000 residents, and 0.03 (95% CI, -0.04 to -0.02) fewer weekly COVID-19 staff cases. In the secondary analysis of the Omicron wave (December 5, 2021, to January 30, 2022), increasing staff vaccination rates were not associated with lower rates of adverse COVID-19 outcomes in nursing homes. Conclusions and relevance: The findings of this cohort study suggest that before the Omicron variant wave, increasing staff vaccination rates was associated with lower incidence of COVID-19 cases and deaths among residents and staff in US nursing homes. However, as newer, more infectious and transmissible variants of the virus emerged, the original 2-dose regimen of the COVID-19 vaccine as recommended in December 2020 was no longer associated with lower rates of adverse COVID-19 outcomes in nursing homes. Policy makers may want to consider longer-term policy options to increase the uptake of booster doses among staff in nursing homes.
MeSH term(s)	Aged ; Humans ; United States/epidemiology ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines ; Cohort Studies ; Longitudinal Studies ; SARS-CoV-2 ; Medicare ; Nursing Homes ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-12-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.49002
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Article ; Online: Reimagining Financing and Payment of Long-Term Care.

Werner, Rachel M / Konetzka, R Tamara

Journal of the American Medical Directors Association

2021 Volume 23, Issue 2, Page(s) 220–224

Abstract: The COVID-19 pandemic revealed fundamental problems with the structure of long-term care financing and payment in the United States. The piecemeal system that exists suffers from several key problems, including underfunding, fragmentation across types ... ...

Abstract	The COVID-19 pandemic revealed fundamental problems with the structure of long-term care financing and payment in the United States. The piecemeal system that exists suffers from several key problems, including underfunding, fragmentation across types and sites of care, and substantial variation in payment across states and populations. These problems result in inefficient allocation of resources, limited access to care, substandard quality, and inequities in both access and quality. We propose a new federal benefit for long-term care, most likely as part of the Medicare program. Essential features of this benefit include taxpayer subsidies, along the lines of other Medicare benefits, and coverage across the range of long-term care services, including both residential and home- and community-based care. A new federal benefit has the most potential to break down administrative barriers and improve resource allocation, to ensure adequate payment rates across all states, to expand access to care by spreading risk across the entire Medicare population, and to improve equity by extending coverage to all Medicare beneficiaries who want it. A new federal benefit is politically challenging, requiring bold action by Congress, and entails the risks of administrative challenges and unintended consequences. However, in this case, retaining the status quo remains the far greater risk.
MeSH term(s)	Aged ; COVID-19 ; Humans ; Long-Term Care ; Medicare ; Pandemics ; SARS-CoV-2 ; United States
Language	English
Publishing date	2021-12-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2021.11.030
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Article ; Online: Factors Associated With Racial Differences in Deaths Among Nursing Home Residents With COVID-19 Infection in the US.

Gorges, Rebecca J / Konetzka, R Tamara

JAMA network open

2021 Volume 4, Issue 2, Page(s) e2037431

Abstract: Importance: It is important to understand differences in coronavirus disease 2019 (COVID-19) deaths by nursing home racial composition and the potential reasons for these differences so that limited resources can be distributed equitably.: Objective: ...

Abstract	Importance: It is important to understand differences in coronavirus disease 2019 (COVID-19) deaths by nursing home racial composition and the potential reasons for these differences so that limited resources can be distributed equitably. Objective: To describe differences in the number of COVID-19 deaths by nursing home racial composition and examine the factors associated with these differences. Design, setting, and participants: This cross-sectional study of 13 312 nursing homes in the US used the Nursing Home COVID-19 Public File from the Centers for Medicare and Medicaid Services, which contains COVID-19 cases and deaths among nursing home residents as self-reported by nursing homes beginning between January 1, 2020, and May 24, 2020, and ending on September 13, 2020. Data were analyzed from July 28 to December 18, 2020. Exposures: Confirmed or suspected COVID-19 infection. Confirmed cases were defined as COVID-19 infection confirmed by a diagnostic laboratory test. Suspected cases were defined as signs and/or symptoms of COVID-19 infection or patient-specific transmission-based precautions for COVID-19 infection. Main outcomes and measures: Deaths associated with COVID-19 among nursing home residents. Death counts were compared by nursing home racial composition, which was measured as the proportion of White residents. Results: Among 13 312 nursing homes included in the study, the overall mean (SD) age of residents was 79.5 (6.7) years. A total of 51 606 COVID-19-associated deaths among residents were reported, with a mean (SD) of 3.9 (8.0) deaths per facility. The mean (SD) number of deaths in nursing homes with the lowest proportion of White residents (quintile 1) vs nursing homes with the highest proportions of White residents (quintile 5) were 5.6 (9.2) and 1.7 (4.8), respectively. Facilities in quintile 1 experienced a mean (SE) of 3.9 (0.2) more deaths than those in quintile 5, representing a 3.3-fold higher number of deaths in quintile 1 compared with quintile 5. Adjustment for the number of certified beds reduced the mean (SE) difference between these 2 nursing home groups to 2.2 (0.2) deaths. Controlling for case mix measures and other nursing home characteristics did not modify this association. Adjustment for county-level COVID-19 prevalence further reduced the mean (SE) difference to 1.0 (0.2) death. Conclusions and relevance: In this study, nursing homes with the highest proportions of non-White residents experienced COVID-19 death counts that were 3.3-fold higher than those of facilities with the highest proportions of White residents. These differences were associated with factors such as larger nursing home size and higher infection burden in counties in which nursing homes with high proportions of non-White residents were located. Focusing limited available resources on facilities with high proportions of non-White residents is needed to support nursing homes during potential future outbreaks.
MeSH term(s)	Aged ; Aged, 80 and over ; COVID-19/epidemiology ; COVID-19/ethnology ; COVID-19/mortality ; Cause of Death ; Continental Population Groups ; Cross-Sectional Studies ; Disease Outbreaks ; Homes for the Aged/statistics & numerical data ; Humans ; Infection Control ; Medicaid ; Medicare ; Nursing Homes/statistics & numerical data ; Race Factors ; SARS-CoV-2 ; United States/epidemiology
Language	English
Publishing date	2021-02-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2020.37431
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Article ; Online: Trends In Medicaid Home And Community-Based Services Waivers For Older Adults.

Skira, Meghan M / Wang, Sijiu / Konetzka, R Tamara

Health affairs (Project Hope)

2022 Volume 41, Issue 8, Page(s) 1176–1181

Abstract: During the past several decades, state Medicaid programs have expanded the use of home and community-based services, particularly through Section 1915(c) waivers and Section 1115 demonstration waivers. We document trends from the period 1997-2020 in ... ...

Abstract	During the past several decades, state Medicaid programs have expanded the use of home and community-based services, particularly through Section 1915(c) waivers and Section 1115 demonstration waivers. We document trends from the period 1997-2020 in waivers targeting older adults, focusing on services offered. Nearly every service category saw an increase in coverage and spending, especially support for self-direction and community transition.
MeSH term(s)	Aged ; Community Health Services ; Home Care Services ; Humans ; Medicaid ; United States
Language	English
Publishing date	2022-07-28
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2022.00149
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Article ; Online: Dementia Care Is Widespread In US Nursing Homes; Facilities With The Most Dementia Patients May Offer Better Care.

Mukamel, Dana B / Saliba, Debra / Ladd, Heather / Konetzka, R Tamara

Health affairs (Project Hope)

2023 Volume 42, Issue 6, Page(s) 795–803

Abstract: More than three million US nursing home residents were diagnosed with Alzheimer's disease and related dementias (ADRD) between 2017 and 2019. This number is expected to increase as the population ages and ADRD prevalence increases. People with ADRD ... ...

Abstract	More than three million US nursing home residents were diagnosed with Alzheimer's disease and related dementias (ADRD) between 2017 and 2019. This number is expected to increase as the population ages and ADRD prevalence increases. People with ADRD require specialized care from trained staff. This study addressed two questions: Are residents with ADRD concentrated in nursing homes where they are the majority? If not, what are the implications for their quality of care and life? We answered the first question by determining the ADRD census for each nursing home in the country during the period 2017-19. Using the Minimum Data Set and Medicare claims, we compared characteristics of nursing homes with high and low ADRD census along several dimensions, including staffing, resident outcomes, and resident characteristics. We found that residents with ADRD were dispersed throughout all nursing homes, with fewer than half residing in nursing homes where residents with ADRD accounted for 60-90 percent of the census. Furthermore, only facilities exceeding 90 percent of residents with ADRD seemed to offer better care. These findings raise concerns about the quality of care and life for the majority of residents with ADRD, suggesting that current National Institutes of Health dementia research initiatives and the Biden administration's policies to improve nursing home care should be coordinated.
MeSH term(s)	Humans ; Aged ; United States ; Dementia/epidemiology ; Dementia/therapy ; Medicare ; Alzheimer Disease/epidemiology ; Alzheimer Disease/therapy ; Nursing Homes
Language	English
Publishing date	2023-06-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2022.01263
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Article ; Online: Dementia, nurse staffing, and health outcomes in nursing homes.

Mukamel, Dana B / Ladd, Heather / Saliba, Debra / Konetzka, R Tamara

Health services research

2023

Abstract: Objective: To estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality.: Data sources and study ... ...

Abstract	Objective: To estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality. Data sources and study setting: A national sample of nursing homes during 2017-2019 (pre-COVID). Data included the Payroll-Based Journal, Medicare Claims, Nursing Home Care Compare, and Long-Term Care Focus. Study design: Retrospective, regression analyses. We estimated separate linear models predicting six long-term facility-level outcomes. Independent variables included staffing hours per resident-day (HPRD) interacted with the facility percentage of dementia residents, controlling for other resident and facility characteristics. Data collection/extraction methods: Hospital-based nursing homes, those with fewer than 30% dementia residents, and missing data were excluded. Principal findings: We found that registered nurses and certified nurse assistants HPRDs were likely to exhibit positive returns in terms of outcomes throughout most of the range of HPRD for both high and low-census dementia facilities, although, high- and low-dementia facilities differed in most outcome rates at all staffing levels. Average predicted antipsychotics and activities of daily living as functions of HPRD were worse in higher dementia facilities, independent movement, and hospitalizations did not differ significantly, and Emergency Rooms and pressure sores were worse in lower dementia facilities. Average marginal effects were not statistically different [CI included zero] between the high and low dementia facilities for any outcome. Conclusions: These findings suggest that increasing staffing will improve outcomes by similar increments in both low- and high-dementia facilities for all outcomes. However, at any given level of staffing, absolute differences in outcomes between low- and high-dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps. Further studies are required to identify opportunities for improvement in performance for both low- and high-dementia census facilities.
Language	English
Publishing date	2023-12-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	410435-3
ISSN	1475-6773 ; 0017-9124
ISSN (online)	1475-6773
ISSN	0017-9124
DOI	10.1111/1475-6773.14270
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