THE RELATIONSHIP BETWEEN ECONOMIC ENVIRONMENT, NURSING HOMES BOUNDARIES, THROUGHPUTS, AND OUTPUTS IN THE MIDWEST PRE- AND POST-COVID 19

Abstract

Background: Nursing homes are among the most prevalent healthcare facilities serving individuals aged 65 and older. With 14,817 facilities currently operating across the United States and housing over 1.3 million residents, these institutions play a critical role in long-term care. The Centers for Medicare & Medicaid Services (CMS) regulates and surveys nursing homes and issues deficiency citations and penalties for non-compliance. Despite their importance, the relationship between the economic environment of older adults and key aspects of nursing home operations and characteristics remains insufficiently explored. This study investigates the relationship between economic environment, nursing home boundaries (i.e., market share and number of beds), throughputs, and outputs to address this gap.

Methods: This quantitative research was guided by General Systems Theory (GST) and utilized secondary data from 2,916 nursing homes located across 493 counties in six Midwestern states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. The study focused on two distinct periods, 2017-2019 (pre-COVID) and 2021-2023 (post-COVID). Data analysis was conducted using the Multiple-Indicator-Multiple-Causes Structural Equation Modeling (SEM-MIMIC) Approach.

Results: The Economic environment was associated with both the demand for (-0.238, p<0.001) and quality of care (-13.029, p<0.01) in nursing homes across certain states. Evidence of distributional cost-effectiveness emerged in facilities with higher proportions of female residents (-0.609, p<0.001) and in rural areas (-0.151, p<0.001), though not in facilities with varying resident acuity levels. Additionally, a negative relationship was observed between facility size and quality outputs (-0.799, p<0.001). The findings also suggest that nursing homes adapt and improve by learning from past experiences, and that their quality outputs are influenced by the political landscape. The state of Illinois showed significant outcomes on most of the results.

Conclusion and Policy Implications: Individual median income and household rent burden among individuals aged 65 and older were associated with nursing home operations. Further research is needed to explore gender, socioeconomic, and operational disparities