Get access

Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

Authors

  • Greg Arling,

    1. Indiana University-Purdue University Indianapolis, 334 N Senate Ave. (EE316), Indianapolis, IN 46204,
    Search for more papers by this author
    • Address correspondence to Greg Arling, Ph.D., School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, 334 N Senate Ave. (EE316), Indianapolis, IN 46204. Dr. Arling is with the School of Public and Environmental Affairs, and the Regenstrief Institute/IU center for Aging Research, Indiana University-Purdue University Indianapolis, IN. Robert L. Kane, M.D., is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN. Christine Mueller, R.N., Ph.D., is with the School of Nursing, University of Minnesota, Minneapolis, MN. Teresa Lewis, B.A., is with the Minnesota Department of Human Services, Nursing Facility Rates and Policy Division, Minneapolis, MN.

  • Robert L. Kane,

    1. Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN,
    Search for more papers by this author
  • Christine Mueller,

    1. School of Nursing, University of Minnesota, Minneapolis, MN
    Search for more papers by this author
  • Teresa Lewis

    1. Minnesota Department of Human Services, Nursing Facility Rates and Policy Division, Minneapolis, MN
    Search for more papers by this author

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.

Ancillary