This study examined organizational and market factors associated with nursing homes that are most likely to be early adopters of innovations. Early adopter institutions, defined as the first 20% of facilities to adopt an innovation, are important because they subsequently facilitate the diffusion of innovations to others in the industry.
Two groups of innovations were examined, special care units and subacute care services. I used discrete-time logistic regression analysis and nationally representative data from 13,162 facilities at risk of being early adopters of innovations during twelve 6-month intervals from 1992 to 1997.
Organizational factors that increase the likelihood of early innovation adoption are larger bed size, chain membership, and high levels of private-pay residents. Four market factors that increase the likelihood of early innovation adoption are: a retrospective Medicaid reimbursement methodology, a more competitive environment, higher average income in the county, and a higher number of hospital beds in the county.
This analysis shows that organizational and market characteristics of nursing homes affect their propensity toward early adoption of innovations. Some of the results may be useful for nursing home administrators and policy makers attempting to promote innovation.
"Nursing homes decry emphasis on the negatives of their facilities and the little recognition of the positives. Turnover of nurses, certified nursing assistants, and administrative staff make provision of quality of care and innovation in care extremely difficult (Castle, 2001; Maas, Specht, Buckwalter, Gittler, & Bechen, 2008). It has been especially hard to recruit bachelor-prepared nurses to nursing homes, adding to the difficulty of having nurses adequately prepared to care for older individuals with complex needs in addition to managing a large staff of minimally prepared workers. "
"Castle (2001) examines nursing homes that are pioneer users of new processes and technology since " identifying characteristics associated with this early adoption process could be useful in further facilitating the diffusion of innovations " (Castle 2001, 161). From a sample of more than 13,000 US facilities between 1992 and 1997, the author identifies the first 20 percent of firms to adopt any of 13 innovations, including for example special care units for Alzheimer's disease, AIDS, head trauma or Huntingdon's disease as well as subacute care for physical therapy, cardiac treatment, and dialysis. "
[Show abstract][Hide abstract] ABSTRACT: As demand for long-term care in the United States outpaces public and private funding, it is increasingly important that geriatric are facilities be managed efficiently and that productivity gains be achieved. These goals require a detailed understanding of resource demand and utilization in nursing homes. This paper draws on a panel of Texas nursing homes to estimate substitution elasticities in a translog cost model. We find that many resource pairs are weak substitutes and that significant automation is unlikely to occur unless wage rates rise in relation to the cost of capital prevailing in the sample period.
"Second, we were not able to include years prior to 1996 because some variables, such as the classes of psychotropic medications, were not yet reported in the OSCAR database. Facilities that first reported an D-SCU after 1996 are relatively late adopters, and it is difficult to know how the inclusion of earlier adopters would have affected our findings (Castle, 2001). Third, we considered only the introduction of new D-SCUs and did not try to study the effect of D-SCU closings. "
[Show abstract][Hide abstract] ABSTRACT: This study quantifies the effect of a new dementia special care unit (D-SCU) on the provision of care to all residents in a nursing home (NH).
The authors use data from the On-line Survey Certification and Reporting system to identify free-standing NHs that first reported a D-SCU between 1996 and 2003 (N = 1,519). Fixed-effects models estimate the effect of a new D-SCU on the prevalence of each outcome (physical restraints, feeding tubes, and psychotropic medications) while controlling for secular trends.
For all NHs, the use of physical restraints declined, the use of antipsychotics increased, and other measures remained relatively constant. The introduction of a D-SCU was not associated with changes in trends for any measure.
Differences in care processes between NHs with and without D-SCUs are the result of differences in their underlying approach to care, not the result of care practice diffusion from the D-SCU.
Journal of Aging and Health 11/2008; 20(7):837-54. DOI:10.1177/0898264308324632 · 1.56 Impact Factor
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