The US Nursing Home Industry

by Giacalone; Robert A

• ISBN13: 9780765605740
• ISBN10: 0765605740
• Format: Hardcover
• Copyright: 2000-11-30
• Publisher: Routledge

Summary

An in-depth analysis of the nursing home industry in America -- its past, present, and future. It focuses on the business aspects of the industry, and provides a detailed examination of the main issues concerning all nursing homes -- trends in health care expenditures; the legislative history of the industry; growing demand for care and how to measure it; the present structure of the industry; funding and financing concerns; government regulation; inter-industry competition and opportunities for growth; global comparisons; and public policy considerations.

Author Biography

Joseph A. Giacalone is associate professor and Henry George Chair in Economics at the St. John's University Peter J. Tobin College of Business

Table of Contents

List of Tables	xi
Foreword	xiii
Acknowledgments	xvii
Introduction	xix
National Expenditures on Health and Nursing Home Care	3	(17)
Introduction	3	(1)
Overview of Spending Patterns	3	(6)
Overview of Financing Patterns	9	(2)
Projections of Health Care Expenditures	11	(8)
Implications for the Nursing Home Industry	19	(1)
Legislative and Economic History of the Nursing Home Industry	20	(13)
Introduction	20	(1)
Prior to the Social Security Act of 1935	21	(1)
From Social Security to Medicare	22	(3)
The Medicare/Medicaid Era	25	(2)
Cost Containment: The issue of the 1980s and Beyond	27	(2)
Trends in the 1990s	29	(4)
Elements of Nursing Home Demand	33	(24)
Demographic Trends	33	(3)
Risk Factors for Institutionalization	36	(11)
Theories of Demand	47	(10)
Structure of the Nursing Home Industry	57	(30)
Nursing Homes and Their Characteristics	57	(2)
Nursing Facilities	59	(5)
Nursing Facility Beds	64	(1)
Nursing Facility Residents	65	(5)
Industry Employment and Staffing	70	(6)
Financial Characteristics and Measures	76	(8)
Theories of Supply	84	(3)
Financing Arrangements and Cost Relationships	87	(25)
Payment Patterns for Nursing Home Care	87	(2)
Public Payment Options	89	(7)
Private Payment Options	96	(12)
Cost Relationships	108	(4)
Cost-Containment, Regulation, and Quality Issues	112	(28)
Cost-Containment Approaches	112	(4)
Managed Care	116	(5)
The BBA of 1997	121	(4)
PPS and the Nursing Home Industry	125	(4)
Balanced Budget Refinement Act of 1999	129	(1)
Regulation and Quality	130	(3)
Quality Concepts	133	(4)
Quality by Profit Status	137	(3)
Competitive Challenges and Opportunities: The LTC Continuum (I)	140	(24)
LTC Specialization, Diversification, and Integration	141	(1)
Subacute Care	142	(3)
Data on the Subacute Care Industry	145	(6)
Issues in Subacute Care	151	(2)
Home Health Care	153	(8)
Adult Day Care	161	(3)
Competitive Challenges and Opportunities: The LTC Continuum (II)	164	(19)
Assisted Living	164	(7)
The Market for AL	171	(5)
Continuing Care Retirement Communities	176	(1)
Hospice Care	177	(4)
Integrated Provider Networks	181	(2)
Global Comparisons	183	(15)
Data Considerations	183	(1)
Demographic Considerations	184	(1)
Institutionalization Rates	185	(2)
Comparative Delivery and Financing of LTC Services	187	(8)
The LTC Continuum Outside the United States	195	(1)
Common Aspects of Global LTC Approaches	196	(2)
Public Policy Perspectives	198	(19)
Overview	198	(1)
Reforming LTC Financing	199	(9)
Alternative Delivery Systems	208	(7)
The Likely Reform Scenario: Continuing Incrementalism	215	(2)
Managerial Issues and Challenges	217	(14)
Managerial Challenges	217	(2)
Financial and Human Resource Concerns	219	(5)
Quality and Regulatory Matters	224	(2)
Legal Issues	226	(2)
The Ultimate Issue: A Revenue Crisis	228	(1)
Concluding Thoughts	229	(2)
References	231	(10)
Index	241	(12)
About the Author	253