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Quality of Nursing Homes and Admission of Residents With Alzheimer's Disease and Related Dementias: The Potential Influence of Market Factors and State Policies
Yan Di, Wang Sijiu, Temkin-Greener Helena, Cai Shubing. Journal of the American Medical Directors Association, 2020-06-23
Topic: Risk, prevention and care in population studies
This study aimed to examine the associations between nursing home (NH) quality and prevalence of newly admitted NH residents with Alzheimer's disease and related dementias (ADRD), and to assess the extent to which market-level wages for certified nursing assistants (CNAs) and state Medicaid behavioral and mental health add-on policy may influence such associations. Retrospective cohort study. The analytical sample included 2777 NHs with either high or low quality, located in urban areas of 41 states from 2011 to 2014. The outcome variable was the prevalence of ADRD among newly admitted NH residents. NH quality was defined as dichotomous, based on the Nursing Home Compare (NHC) star rating system. We considered an NH with 5-star rating as having high quality and with 1-star rating as having low quality. Information on county-level CNA wages and state Medicaid behavioral and mental health add-on policies was included. Linear regression models with NH random effects and robust standard errors were estimated. A set of sensitivity analyses were performed. After accounting for NH-level aggregated resident characteristics and market/state-level factors, the prevalence of ADRD among newly admitted residents was 3% lower in high-quality NHs compared with low-quality NHs (P < .01). A 1-dollar increase in CNA hourly wage was associated with a 0.9-percentage point decrease in the prevalence of ADRD among newly admitted residents (P < .01). State Medicaid behavioral and mental health add-on policy was associated with a 2.5-percentage point increase in the prevalence of ADRD in high-quality NHs (P < .05), but not in low-quality NHs. Our findings suggest that high-quality NHs are less likely to admit residents with ADRD. The effect size of this relationship is modest and may be influenced by state Medicaid behavioral and mental health add-on policies. Future studies are needed to better understand reasons leading to these associations so that effective interventions can be developed to incentivize high-quality NHs to more readily serve residents with ADRD.
Key findings
- After accounting for NH-level aggregated resident characteristics and market/state-level factors, the prevalence of ADRD among newly admitted residents was 3% lower in high-quality NHs compared with low-quality NHs (P < .01).
- A 1-dollar increase in CNA hourly wage was associated with a 0.9-percentage point decrease in the prevalence of ADRD among newly admitted residents (P < .01).
- State Medicaid behavioral and mental health add-on policy was associated with a 2.5-percentage point increase in the prevalence of ADRD in high-quality NHs (P < .05), but not in low-quality NHs.
- Our findings suggest that high-quality NHs are less likely to admit residents with ADRD.
Why it matters
This study found that high-quality nursing homes had a slightly lower prevalence of newly admitted residents with dementia, and that higher certified nursing assistant wages were linked to lower prevalence. It describes market and policy factors related to nursing home admissions, not treatment or cure.
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Study details
- Study designcohort study
- Participants2,777
- Evidence strengthModerate
How this study scored 49/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Medical Directors Association) |
| Journal's citation record | 2 / 4 | Journal of the American Medical Directors Association: journal h-index 172 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,777 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 11 times (OpenAlex, 2026-10-17) |
| Citations per year | 1 / 5 | 1.4 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 2 / 6 | Cited 1.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Shubing Cai: h-index 21 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Rochester: institution h-index 1,191 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32565275) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 49 / 100 | — |
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APA 7th
Di, Y., Sijiu, W., Helena, T.-G., & Shubing, C. (2020). Quality of Nursing Homes and Admission of Residents With Alzheimer's Disease and Related Dementias: The Potential Influence of Market Factors and State Policies. Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2020.04.028
Vancouver
Di Y, Sijiu W, Helena T.-G, Shubing C. Quality of Nursing Homes and Admission of Residents With Alzheimer's Disease and Related Dementias: The Potential Influence of Market Factors and State Policies. Journal of the American Medical Directors Association. 2020. doi:10.1016/j.jamda.2020.04.028. PMID: 32565275.
BibTeX
@article{di2020-32565275,
author = {Di, Yan and Sijiu, Wang and Helena, Temkin-Greener and Shubing, Cai},
title = {{Quality of Nursing Homes and Admission of Residents With Alzheimer's Disease and Related Dementias: The Potential Influence of Market Factors and State Policies}},
journal = {Journal of the American Medical Directors Association},
year = {2020},
doi = {10.1016/j.jamda.2020.04.028},
pmid = {32565275},
url = {https://doi.org/10.1016/j.jamda.2020.04.028}
}