In 2009, the Government Accountability Office reported that 15% of federal nursing home (NH) recertification surveys nationwide and 25% of surveys in nine states underscored serious deficiencies in nursing care provided to 1.5 million residents residing in NHs. The state nursing home survey agencies' surveyors attributed the Centers for Medicare and Medicaid Services (CMS) administrative rules and the documents in the surveyor guidance manual as too complex and ambiguous to correctly assign deficiency severity scores. In review of nursing literature, it was noted that standardized nursing language can increase the clarity of complex systems. The premise of this exploratory study was to determine if the standardized language of the Nursing Outcomes Classification (NOC) could provide a cross-linkage of the CMS rules, indicators of substandard nursing care, and the full guidance manual used to assign deficiency severity scores. The study attempted to achieve this goal by aligning select NOC outcomes and indicators with nursing outcomes indicators in the CMS administrative rules, select documents in the surveyor guidance manual and select documents in the Quality Indicator Survey. The data analysis suggested the relationship of the origin of the CMS rule and documents to the degree of alignment with the select NOC outcomes and indicators. It was also found that the intent of the CMS rule and select documents shared common themes. In addition, the data analysis revealed that the CMS rule and select documents aligned in various degrees with all of the selected NOC outcomes and respective indicators. The data analysis confirmed that there is sufficient evidence of a degree of alignment of select NOCs with the CMS rule and documents in the guidance manual for activities of daily living and functional status. Furthermore, the data analysis confirmed that this body of work can be a baseline for future research to develop an NOC specific to NHs as a viable cross-link to the CMS rules and guidance manual.

The coronavirus pandemic exposed the systemic issues faced by nursing homes with a higher percentage of Medicaid residents. By using the Brown University's Long-Term Care focus facility-level data and the Centers for Medicare and Medicaid Services data, the study examines the association between the nursing home and resident characteristics with Covid-19 cases in high-Medicaid nursing homes. Fifty-eight facilities in Florida were identified as having residents whose primary support was Medicaid. The findings from the study suggest a higher proportion of Medicaid residents, for-profit status, and chain affiliation status, were associated with a higher prevalence of Covid-19 cases among nursing home residents. Further research on related health policies is necessary to resolve the current disparities in nursing home care serving a higher proportion of Medicaid residents.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-01, page: 0311. Adviser: Osama Mikhail. Includes bibliographical references.

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