Explaining direct care resource use of nursing home residents: Findings from time studies in four states

Gregory Arling, Robert L. Kane, Christine Mueller, Teresa Lewis

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective. To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods. Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents.

Original languageEnglish
Pages (from-to)827-846
Number of pages20
JournalHealth Services Research
Volume42
Issue number2
DOIs
StatePublished - Apr 2007

Fingerprint

Time and Motion Studies
Diagnosis-Related Groups
nursing home
Nursing Homes
Nursing
resident
resources
Information Storage and Retrieval
Salaries and Fringe Benefits
Medicaid
Carbon Monoxide
utilization
Group
Length of Stay
Hand
Nurses
Costs and Cost Analysis
nursing
Health
time

Keywords

  • Case mix
  • Hierarchical linear model
  • Nursing home
  • Payment
  • Reimbursement

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Explaining direct care resource use of nursing home residents : Findings from time studies in four states. / Arling, Gregory; Kane, Robert L.; Mueller, Christine; Lewis, Teresa.

In: Health Services Research, Vol. 42, No. 2, 04.2007, p. 827-846.

Research output: Contribution to journalArticle

Arling, Gregory ; Kane, Robert L. ; Mueller, Christine ; Lewis, Teresa. / Explaining direct care resource use of nursing home residents : Findings from time studies in four states. In: Health Services Research. 2007 ; Vol. 42, No. 2. pp. 827-846.
@article{1f7deebf5b934731a5024670b517ff0f,
title = "Explaining direct care resource use of nursing home residents: Findings from time studies in four states",
abstract = "Objective. To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods. Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents.",
keywords = "Case mix, Hierarchical linear model, Nursing home, Payment, Reimbursement",
author = "Gregory Arling and Kane, {Robert L.} and Christine Mueller and Teresa Lewis",
year = "2007",
month = "4",
doi = "10.1111/j.1475-6773.2006.00627.x",
language = "English",
volume = "42",
pages = "827--846",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Explaining direct care resource use of nursing home residents

T2 - Findings from time studies in four states

AU - Arling, Gregory

AU - Kane, Robert L.

AU - Mueller, Christine

AU - Lewis, Teresa

PY - 2007/4

Y1 - 2007/4

N2 - Objective. To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods. Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents.

AB - Objective. To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods. Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents.

KW - Case mix

KW - Hierarchical linear model

KW - Nursing home

KW - Payment

KW - Reimbursement

UR - http://www.scopus.com/inward/record.url?scp=33947169326&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33947169326&partnerID=8YFLogxK

U2 - 10.1111/j.1475-6773.2006.00627.x

DO - 10.1111/j.1475-6773.2006.00627.x

M3 - Article

C2 - 17362220

AN - SCOPUS:33947169326

VL - 42

SP - 827

EP - 846

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 2

ER -