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Studies: Nursing Homes Increased In Size And Decreased In Quality, As More Residents Chose Community Options
By Dave Reynolds, Inclusion Daily Express
August 11, 2005

SAN FRANCISCO, CALIFORNIA--According to two studies published this month by the University of California, San Francisco, there has been a decline since 1990 in the number of Americans nursing homes and other institutions as seniors and younger adults with disabilities chose community-based alternatives.

Those who have remained in nursing homes during the past six years, however, experienced deteriorating quality of care and sanitation.

Researchers with UCSF studied state long-term care data to learn that the number of nursing home beds increased by just 7 percent, while community residential care and assisted living beds increased by 97 percent from 1990 to 2002. Beds in institutional "intermediate care facilities for the mentally retarded and developmentally disabled" (ICF-MR/DDs) actually declined by 27 percent.

"These changing trends in the supply of long-term care can be expected to continue because the demand for home and community based services is growing," said Charlene Harrington, RN, PhD, the lead author of the study entitled, "Trends in the Supply of Long-Term-Care Facilities and Beds in the United States", published in this month's Journal of Applied Gerontology.

Another UCSF study, published online by the Center for Personal Assistance Services, analyzed nursing home staffing patterns, resident characteristics and facility deficiencies documented from the period between 1998 and 2004.

That study found that while the number of nursing homes decreased modestly by 5 percent, from 15,401 in 1998 to 15,138 in 2004, there was an overall increase in the number of people in nursing homes. This is partly because facilities have grown in size: The overall average size of certified facilities was 99 beds in 1998 while the average increased to 107 beds per facility in 2004.

The data showed significant problems with nursing homes failing to follow federal regulations. Over the six-year period the number of deficiencies actually increased by 43 percent. The study noted that 32 percent of all nursing homes have sanitary problems, while 24 percent have quality of care problems.

The researchers also found a dramatic decline in the skills and training of nursing home staff since 1998. The average number of registered nurse hours dropped by 25 percent while the number of nursing assistants increased to make up the difference.

On the positive side, the rates of residents in physical restraints declined by 39 percent, and the percent of facilities receiving serious deficiencies for "causing harm or jeopardy" declined by almost half, from 30 percent in 1998 to 15.5 percent in 2004.

"This suggests that quality is improving or states are less likely to give serious deficiencies," the authors commented. "There is little evidence of improved quality so it is more likely that a change in the survey ratings of deficiencies has occurred."

"Assisted Living and In Home Care Increase as Nursing Home Beds Decline" (
Abstract: "Trends in the Supply of Long-Term-Care Facilities and Beds in the United States" (Journal of Applied Gerontology)
Abstract: "Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1998 Through 2004" (Center for Personal Assistance Services)
Full Version: "Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1998 Through 2004" (Center for Personal Assistance Services)


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