Project 5 - Effects of Nursing Home Payment on Patient-Centered Outcomes for Older Adults and People with ADRD

Nursing homes are key sources of care for millions of older adults, especially those with dementia, but many facilities are unable to consistently deliver high-quality care for these vulnerable patients. One potential policy to address inadequate quality and safety is to raise payment rates for these facilities, thereby encouraging facilities to employ more resources and treat more patients, for instance through increased nurse staffing. This project analyzes this approach, focusing specifically on how payment rates affect care quality. The project takes advantage of two policy reforms, implemented in 2010 and 2019, that overhauled Medicare’s skilled nursing facility (SNF) payment system, changing the payments for thousands of facilities (homes) by 5% or more. It considers the effects of Medicare payment rates on the quality and safety of care for skilled nursing patients, the mechanisms like staffing that drive these effects, "spillover" effects onto long-stay patients, and the implications of payment changes for disparities in care access and quality. These results will illuminate the benefits and potential unintended consequences of payment reforms and guide future efforts to improve healthcare quality and value for individuals with dementia.