Nursing Home Divestiture and Corporate Retructuring: Final Report

摘要

Over the past two decades, the nursing home industry has experienced changes in the financial, regulatory, and competitive environments. Nursing homes have been greatly impacted by federal and state policies, such as the regulatory reforms of the Omnibus Budget Reconciliation Act of 1987 and the payment reforms of the Balanced Budget Act of 1997. Occupancy rates have fallen in the context of shortened lengths of stay for residents and increased competition from assisted living facilities and other home and community-based care. State Medicaid payment rates vary substantially across states and have gone through periods of relative generosity and parsimony. Nursing home malpractice litigation has increased causing an increase in overall operating costs, especially in a handful of states. The analyses highlighted several issues for policymakers, stakeholders, and researchers, including areas where further research is needed. Importantly, the analyses show that there is substantial variation across national chain providers in the strategies by which they navigate policy and market conditions. Thus, in researching nursing home chains in comparison to the rest of the nursing home industry, it is important to focus beyond the dichotomous Yes/No of whether a facility is part of a chain and to investigate more about the specific characteristics and practices of the parent company.