Predicting lawsuits against nursing homes in the United States, 1997-2001

Health Services Research, Dec, 2004 by Christopher E. Johnson, Aram Dobalian, Janet Burkhard, Deborah K. Hedgecock, Jeffrey Harman

Table 1: Descriptive Statistics for Nursing Homes Sample, 1997-2001
(N = 2,378)

                                            Descriptive Statistics

                                           Mean or %          SD

Dependent Variables
  Lawsuits per home per year                   0.22              0.69
Quality Variables
  Met CMS recommended long stay CNA           17.1%
    staffing levels per any year
  Met CMS recommended long stay                7.1%
    LPN RN staffing levels per any year
  Met CMS recommended long stay RN            14.0%
    staffing levels per any year
  Skin pressure sores developed in the         0.036     [  or -] 0.037
    nursing home ratio per year
  Total survey deficiencies per year           5.50      [  or -] 6.02
    Actual harm citation                      27.7%
Resource Variables
  System membership                           31.8%
  Medicaid resident ratio per year             0.66      [  or -] 0.22
  Nursing home size (no. of beds) per        118.28     [  or -] 60.29
    year
  For-profit                                  75.0%
Market Variables
  Resident rights state                       52.4%
  State complaint mean number                350.1     [  or -] 411.22
  Mean minutes for state complaint           986.25    [  or -] 735.91
    investigation
Control Variables
  Residents requiring tube feeding ratio       0.073     [  or -] 0.069
    per year
  Residents bowel incontinent ratio per        0.46      [  or -] 0.18
    year
  New residents requiring catheters in         0.019     [  or -] 0.03
    the nursing home ratio per year
  Total residents per year                   100.16     [  or -] 53.35

                                              Min.       Max.

Dependent Variables
  Lawsuits per home per year                   0          18
Quality Variables
  Met CMS recommended long stay CNA
    staffing levels per any year
  Met CMS recommended long stay
    LPN RN staffing levels per any year
  Met CMS recommended long stay RN
    staffing levels per any year
  Skin pressure sores developed in the         0           1
    nursing home ratio per year
  Total survey deficiencies per year           0          62
    Actual harm citation
Resource Variables
  System membership
  Medicaid resident ratio per year             0           1
  Nursing home size (no. of beds) per          10        657
    year
  For-profit
Market Variables
  Resident rights state
  State complaint mean number                  0       4,129
  Mean minutes for state complaint             96      4,981
    investigation
Control Variables
  Residents requiring tube feeding ratio       0           1
    per year
  Residents bowel incontinent ratio per        0           1
    year
  New residents requiring catheters in         0           0.76
    the nursing home ratio per year
  Total residents per year                     1         633

Table 2: Variable Specification

Dependent Variables

Total Lawsuits Filed                = Total lawsuits brought against
                                      the nursing home for that year
Quality Variables
  Met CMS recommended long stay     = 1 if nursing home met the 2.8
    CNA staffing levels per any       CNA hour per resident day
    year                              standard for that year
  Met CMS recommended long stay     = 1 if nursing home met the 1.3
    LPN RN staffing levels per any    LPN RN hour per resident day
    year                              standard for that year
  Met CMS recommended long stay RN  = 1 if nursing homes met the 0.75
    staffing levels per any year      hour per resident day standard
                                      for that year
  Skin pressure sores developed in  = Total skin sores in home minus
    the nursing home ratio per        total skin sores at admission
    year                              divided by total residents for
                                      that year
  Total survey deficiencies per     = Total number of health survey
    year                              deficiencies for that year
  Actual harm citation              = 1 if nursing home was cited for
                                      an actual harm severity (G or
                                      higher) on the licensing survey
Resource Variables
  System membership                 = 1 if nursing home was a member
                                      of a 30 facility or greater
                                      nursing home chain
  Medicaid resident ratio per year  = Total number of Medicaid
                                      residents divided by total
                                      residents for that year
  Nursing home size (no. of beds)   = Total number of nursing home
    per year                          beds for that year
  For-profit                        = 1 if nursing home is a
Market Variables                      for-profit organization
  Resident rights state             = 1 if state has residents rights
                                      laws
  State complaint mean number       = Mean number of complaints per
                                      100 beds for the state home is
                                      located in
  Mean minutes for state complaint  = Mean hours it takes state to
    investigation                     investigate complaint from time
                                      filed to investigation initiated
Control Variables
  Residents requiring tube feeding  = Total residents tube feeding
    ratio per year                    dependent divided by total
                                      residents for that year
  Residents bowel incontinent       = Total bowel incontinent
    ratio per year                    residents divided by total
                                      residents for that year
  New residents requiring           = Total catheter patients in home
    catheters in the nursing home     minus total catheter patients at
    ratio per year                    admission divided by total
                                      residents for that year
Year *                              = 1 for year (Year 1997, Year
                                      1998, Year 1999, Year 2000, Year
                                      2001)

* 1997 was the omitted comparison year for the analysis.

Table 3: Negative Binomial Regression Results

                                         Total Lawsuits per Year

Explanatory and Control Variables         Incidence    Standard
                                          Rate Ratio    Error

Quality Variables
  Met CMS recommended long stay              0.85       0.083
   CNA staffing levels per any year
  Met CMS recommended long stay              1.21       0.173
   LPN RN staffing levels per any year
  Met CMS recommended long stay              0.77       0.086
   RN staffing levels per any year
  Skin pressure sores developed in the       0.99       0.009
   nursing home ratio per year
  Total survey deficiencies per year         1.03       0.004
  Actual harm citation                       1.03       0.064
Resource Variables
  System membership                          0.84       0.07
  Medicaid resident ratio per year           0.99       0.001
  Nursing home size (# of beds) per year     1.01       0.001
  For-profit                                 1.28       0.14
Market Variables
  Resident rights state                      1.61       0.127
  State complaint mean number                0.99       0.0001
  Mean minutes for state complaint           0.99       0.0001
   investigation
Control Variables
  Residents requiring tube feeding           1.05       0.006
   ratio per year
  Residents bowel incontinent                1.00       0.002
   ratio per year
  Residents requiring catheters in the       0.96       0.011
   nursing home ratio per year
  Year 1998                                  1.17       0.094
  Year 1999                                  1.25       0.093
  Year 2000                                  1.17       0.093
  Year 2001                                  1.54       0.129

                                          Total Lawsuits per Year

Explanatory and Control Variables          Z-Score

Quality Variables
  Met CMS recommended long stay            -1.69 *
   CNA staffing levels per any year
  Met CMS recommended long stay             1.33
   LPN RN staffing levels per any year
  Met CMS recommended long stay            -2.36 **
   RN staffing levels per any year
  Skin pressure sores developed in the     -0.64
   nursing home ratio per year
  Total survey deficiencies per year        5.95 ***
  Actual harm citation                      0.48
Resource Variables
  System membership                        -2.11 **
  Medicaid resident ratio per year         -1.28
  Nursing home size (# of beds) per year   11.74 ***
  For-profit                                2.24 **
Market Variables
  Resident rights state                     6.05 ***
  State complaint mean number              -3.65 ***
  Mean minutes for state complaint         -4.46 ***
   investigation
Control Variables
  Residents requiring tube feeding          9.30 ***
   ratio per year
  Residents bowel incontinent               0.51
   ratio per year
  Residents requiring catheters in the     -3.19 ***
   nursing home ratio per year
  Year 1998                                 1.89 *
  Year 1999                                 3.04 ***
  Year 2000                                 1.95 *
  Year 2001                                 5.20 ***

* Significant at the .10 level;

** Significant at the .05 level;

*** Significant at the .01 level.