Dissertation Title： "The Consumer’s Role in Nursing Home Quality"My thesis focuses on the consumer's role in nursing home quality. Using five years of data from Massachusetts Department of Public Health (1998-2002), the first chapter explores whether consumer complaints might be used to assess quality of care in nursing homes. Although complaints have been critical to nursing home oversight, the potential of complaints in quality assessment has been unexplored. I find that complaints vary across facilities in ways that are consistent with the nursing home quality literature and that they track well with other nursing home quality measures. I conclude that nursing home consumer complaints provide a supplemental tool with which to differentiate facilities on quality.
The second chapter focuses on recent trends in nursing home litigation, which has emerged over the last decade to become one of the fastest growing areas of health care litigation. Using a web-based survey of attorneys who bring and defend this type of litigation nationwide, we explore the scale, dynamics, and outcomes of this litigation. Respondents and their firms were involved, respectively, in 4,677 and 8,256 claims in 2001, over half of which were in Florida and Texas. Data show that the costs of nursing home litigation are substantial on an aggregate and per-claim basis. These findings elevate concerns about nursing home quality and indicate that litigation may divert resources from resident care.
The third chapter focuses on the potential of using publicly-reported quality information to inform consumers' nursing home placement decisions and to improve quality of care. Although there is an extensive reporting literature in the acute sector, this approach is relatively new in long-term care. Beyond identifying potential barriers to such efforts, I evaluate whether the quality information reported on the Nursing Home Compare website had any impact on nursing home occupancy rates following its release. I find that the effect of public reporting on nursing home occupancy rates has been minimal thus far. It is unclear whether the absence of a larger effect to date is specific to Nursing Home Compare, or whether it inheres to the broader task of using information to promote change in nursing home care.