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OCR for page 213
Notes
CHAPTER 1
The original contract specified a 22-month study. The
contract completion date was subsequently extended 7
months.
2. U.S. Senate Special Committee on Aging. 1974. Nursing
Home Care in the United States: Failure in Public
Policy. Washington, D.C.: U.S. Government Printing
Office.
3. Mendelson, Mary Adelaide. 1974. Tender Loving
Creed.
4. Moss, Frank, and Vat Halamanderis. 1977. Too Old,
Too Sick, Too Bad--Nursing Homes in America.
Germantown, Maryland: Aspen Systems Corporation.
5. Arkansas Legislative Joint Performance Review
Committee. 1978. Nursing Home Study--1978: Evaluation
of State Regulation of the Nursing Home Industry.
6. Commission on California State Government
Organization and Economy. 1983. The Bureaucracy of
Care: Continued Policy Issues for Nursing Home
Services and Regulation.
7. Auditor General of California. 1982. The Department
of Health Services. Long-Term Care Facilities.
213
OCR for page 214
214/ NOTES
S. Colorado Attorney General's Office. 1977. Report of
the Attorney General Concerning the Regulation of the
Nursing Home Industry in the State of Colorado.
9. Governor's Blue Ribbon Nursing Home Commission. 1976,
1980. Report of the Blue Ribbon Committee to
Investigate the Nursing Home Industry in Connecticut.
10. Office of the Inspector General, Florida Department
of Health and Rehabilitative Services. 1981. Nursing
Home Evaluative Report.
1. Office of the Inspector General, Florida Department
of Health and Rehabilitative Services. 1983. An
Evaluation of the District XI Long-Term Care Unit.
12. Illinois Legislative Investigating Commission. 1984.
Regulation and Funding of Illinois Nursing Homes.
13. Maryland Commission on Nursing Homes. 1973. Report of
the Governor's Commission on Nursing Homes.
14. Plante and Moran Consultants Inc. 1981. Michigan
Department of Public Health, Bureau of Health Care
Administration, Division of Health Facilities
Certification and Licensure Management and Operations
Review.
15. Minnesota House and Senate Select Committees on
Aging. 1976. Final Report, Nursing Home Study.
16. New Jersey State Nursing Home Study Committee. 1978.
New Jersey Report on Long-Term Care.
17. New York State Moreland Act Commission. 1975.
Regulating Nursing Home Care: The Paper Tigers.
18. New York State Moreland Act Commission. 1976.
Long-Term Care Regulation: Past Lapses, Future
Prospects.
19. Ohio General Assembly Nursing Home Commission. 1978.
A Program in Crisis: An Interim Report.
20. Ohio General Assembly Nursing Home Commission. 1979.
A Program in Crisis: Blueprint for Action.
21. Oregon Joint Interim Nursing Home Task Force. 1978.
Report of the Joint Interim Task Force on Nursing
Homes.
22. State of Texas Nursing Home Task Force. 1979. Report
on Nursing Homes to the Attorney General of the State
of Texas.
23. Joint Legislative Audit and Review Commission. 1978.
Long-Term Care in Virginia.
OCR for page 215
NOTES/215
24. Spalding, Joy. 1985. A Consumer Perspective on
Quality Care: The Residents' Point of View. Analysis
of Residents' Discussions. National Citizens'
Coalition for Nursing Home Reform. Washington, D.C.
25. Weisbrod, B. A., and M. Schlesinger. December 1983.
Public, Private, Non-Profit Ownership and the
Response to Asymmetric Information: The Case of
Nursing Homes. Unpublished paper.
26. U.S. House of Representatives. Select Committee on
Aging. July 1985. America's Elderly at Risk.
Washington, D.C.: U.S. Government Printing Office.
27. Scanlon, William J. 1980. Nursing Home Utilization
Patterns: Implications for Policy. Journal of
Health Politics, Policy and Law 4~4~:619-641.
28. The terms "patients" and "residents" often are used
interchangeably when referring to the recipients of
care in nursing homes. The current federal
regulations pertaining to Skilled Nursing Facilities
use the term "patients." The Intermediate Care
regulations refer to "residents." The committee
prefers the term "residents" for those being cared
for in nursing homes because it more clearly conveys
the idea that most people admitted to nursing homes
live in them for many months or years.
29. The committee received testimony to this effect from
dozens of witnesses at the public meetings it
conducted in Philadelphia, Atlanta, Dallas,
Minneapolis, and Los Angeles in September 1984.
Similar testimony was recorded in public hearings
conducted by the HCFA in 1978.
30. Katz, S., and C. A. Akpom. 1976. A Measure of
Primary Sociobiological Function. International
Journal of Health Sciences 6~3~:493-507. The
"activities of daily living" are bathing, dressing,
toileting, transfer, continence, and feeding.
31. Scanlon, W. J., and J. Feder. January 1984. The
Long-Term Care Marketplace: An Overview. Health
Care Financial Management. Pp. 1-13.
32. These pressures are attributable primarily to
demographic trends--the rapid growth in the numbers
of very old and very frail elderly persons in the
population, and the constraints on nursing home bed
OCR for page 216
216/ NOTES
supply which have resulted in a nursing home bed
shortage in most parts of the country.
Unfortunately, good recent data to demonstrate the
increasing proportion of heavy-care residents are not
available. The last national nursing home survey was
conducted in 1977. The National Center for Health
Statistics now plans to conduct its next national
survey of nursing homes in 1986. The most recent
analysis of the available data is contained in: U.S.
General Accounting Office. 1983. Medicaid and
Nursing Home Care: Cost Increases and the Need for
Services Are Creating Problems for the States and the
Elderly. Report to the Chairman of the Subcommittee
on Health and the Environment, Committee on Energy
and Commerce, U.S. House of Representatives.
GAO/IPE-84- 1, October 21, 1983.
33. Health Care Financing Administration
. 1985.
Unpublished data based on "cleaned" 1984
Medicare/Medicaid data.
34. U.S. Department of Health and Human Services, Office
of Inspector General. April 1982. Board and Care
Homes: A Study of Federal and State Actions to
Safeguard the Health and Safety of Board and Care
Home Residents. Washington, D.C.
35. Sirrocco, A. 1983. An Overview of the 1980 National
Master Facility Inventory Survey of Nursing and
Related Care Homes. National Center for Health
Statistics.
36. National Center for Health Statistics. 1981.
Utilization Patterns and Financial Characteristics of
Nursing Homes in the United States: 1977 National
Nursing Home Survey. Data from the National Health
Survey Series B. No. 53, HHS Pub. No. (PH5) 81-1714.
37. U.S. Senate, Special Committee on Aging. 1984.
Developments in Aging: 1983. Vol. 1. Washington,
D.C.
38. Arnett, R. H. III, C. S. Cowells, L. M. Davidoff, and
M. S. Freeland. Spring 1985. Health Spending Trends
in the 1980s. Health Care Financing Review.
U.S. Department of Labor, Bureau of Labor Statistics.
1984. Employment Projections for 1995, Bulletin 2197.
Washington, D.C.
40. U.S. Department of Health, Education, and Welfare.
1974. Enforcement of Life Safety Code Requirements in
OCR for page 217
NOTES/217
Skilled Nursing Facilities. Office of Nursing Home
Affairs, Public Health Service. January.
41. Smith v. Heckler, 747 F.2d 583 (lOth Cir. 1984~.
Smith v. O'Halloran, 557 F. Supp. 289 (D. Colo.
1983), rev'd sub nom.
42. Kemanis, V. 1980. A Critical Evaluation of the
Federal Role in Nursing Home Quality Enforcement, 51
University of Colorado Law Review 607.
43. Estimated. The actual fraction may be larger. In
states with "medically needy" programs, many of the
residents with private incomes below the "medically
needy" eligibility ceiling share the costs of nursing
home care with Medicaid.
44. National Center for Health Statistics. 1979. The
National Nursing Home Survey: 1977 Summary for the
United States, Vital and Health Statistics. Data from
the National Health Survey Series 13, No. 43. HHS
Pub. No. (PHS) 79-1794.
45. U.S. General Accounting Office. October 1983.
Medicaid and Nursing Home Care: Cost Increases and
the Need for Services Are Creating Problems for the
States and the Elderly. Report to the Chairman of
the Subcommittee on Health and the Environment,
Committee on Energy and Commerce, House of
Representatives.
46. Systemetrics, Inc. December 1983. The MMACS Long-Term
Care Data Base: Construction of a New Research File
and an Assessment of Its Quality and Usefulness.
Report prepared for the Health Care Financing
Administration.
CHAPTER 2
1. National Center for Health Statistics. April 1981.
Characteristics of Nursing Home Residents, Health
Status, and Care Received: National Nursing Home
Survey, United States, May-December 1977. U.S.
Department of Health and Human Services Pub. No.
(PHS) 81-1712.
2. Linn, M., and J. Mossey. Summer 1980. The Role of
Payment Sources in Differentiating Nursing Home
Residents, Services and Payments. Health Care
Financing Review.
OCR for page 218
218/NOTES
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12. Kurowski, B., and P. Shaughnessy. 1982. The
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NOTES /219
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NOTES/223
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NOTES/227
CHAPTER 3
U.S. Department of Health and Human Services. 1985.
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OCR for page 229
NOTES / 229
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CHAPTER 4
1. U.S. General Accounting Office. October 14, 1982.
Audit of Medicaid Costs Reported by Autumn Hills
Convalescent Centers, Houston, Texas. Washington,
D.C.: GAO/HRD-83-9.
2. Smith v. O'Halloran, 557 F. Supp. 289 (13. Colo.
1983), rev'd sub nom. Smith v. Heckler, 747 F.2d
583 (1Oth Cir. 1984).
3. Health Care Financing Administration, Health
Standards Quality Bureau. 1981. Unpublished analysis
of 1981 MMACS data.
4. Systemetrics, Inc. December 1983. The MMACS Long-Term
Care Data Base: Construction of a New Research File
and an Assessment of Its Quality and Usefulness.
5. Shaughnessy, P. W., R. Schlenker, and I. Yslas. 1983.
Case Mix, Quality, and Cost: Major Findings and
Implications of the Colorado Nursing Home Study.
Center for Health Services Research, University of
Colorado Health Sciences Center. Denver, Colorado.
6. Kurowski, B., and P. W. Shaughnessy. 1983. The
Measurement and Assurance of Quality. Chapter IV in
Long-Term Care: Perspectives front Research and
Demonstrations. R. J. Vogel and H. C. Palmer
(eds.~. Washington, D.C.: Health Care Financing
Administration, U.S. Department of Health and Human
Services.
OCR for page 231
NOTES/231
Schneider, D., and A. O'Sullivan. 1980. Quality
Assurance for Long-Term Care: Revising the Periodic
Review. Schneider and Associates. Troy, New York.
Mimeograph.
8. Massachusetts Department of Public Health. 1984.
Quality Assurance by Sampling: First Annual Report.
August 29, 1983-February 14, 1984. Unpublished.
Wisconsin Department of Health and Social Services,
Division of Health. 1979. Annual Report: Nursing Home
Quality Assurance Project, FY 1978-1979. Madison,
Wisconsin.
10. Colorado Department of Health, Medical Care Licensing
and Certification Division. 1980. "QC" Factors, a
Relationship Between Computerization, Patient Care,
and the Regulatory Process. Denver, Colorado.
11. Illinois Department of Public Health and Medicus
Systems Corporation. November 1976. Regulatory Use of
a Quality Evaluation System for Long-Term Care. Final
report to Department of Health, Education, and
Welfare, Contract #HSM 110-73-499.
12. Ohio Nursing Home Commission. 1979. A Program in
Crisis: Blueprint for Action. Final Report of the
Ohio Nursing Home Commission. Ohio General Assembly.
Columbus.
13. Shanks, N., et al. 1983. Evaluation of the
Reimbursement Provisions of Amended Substitute House
Bill 176. A Report to the Ohio Department of Public
Welfare. Center for Health Services Research,
University of Colorado Health Sciences Center.
Denver.
14. Lee, Y. S., and S. Braun. 1981. Health Care for the
Elderly: Designing a Data System for Quality
Assurance. Computers, Environment, and Urban
Systems 6(Spring):49-82.
15. Lee, Y. S. 1984. Performance of Intermediate Care
Facilities in Iowa: A Preliminary Analysis. Performed
for the Iowa Department of Health, Division of Health
Facilities [or Nursing Homes and Quality of Health
Care: The First Year of Results of an
Outcome-Oriented Survey. Journal of Health and
Human Resource Administration 7(Summer): 32-601.
OCR for page 232
232 / NOTES
16. Bisenius, M. F. 1984. Quality of Health Care in Iowa
Nursing Homes: Results from the ICE Outcome-Oriented
Survey, December 1, 1982-November 20, 1983. Iowa
State Department of Health, Division of Health
Services, Des Moines.
17. New York Department of Health. May 1984. Report to
the Governor and the Legislature on the New
Surveillance Process for New York State Residential
Health Care Facilities. Office of Health Systems
Management. Albany, New York.
18. Mathematica Policy Research, Inc. January 1985.
Evaluation of the State Demonstrations in Nursing
Home Quality Assurance Processes. Final report.
19. DiBernardis, J., and D. Gitlin. November 1979.
Identifying and Assessing Quality Care in Long-Term
Care Facilities in Montana. Report to the Department
of Social Rehabilitation Services, State of Montana,
under Contract No. 80-070-0016. Center of
Gerontology, Montana State University. Bozeman.
20. Donabedian, A. 1980. Explorations in Quality
Assessment and Monitoring. Vol. 1: The De f inition of
Quality and Approaches to Its Assessment. Ann
Arbor, Michigan: Health Administration Press.
21. Glascock, J. 1985. The Modified Survey
Process--Traditional Survey Process Evaluation
Project. Seattle, Washington: The Hesperides Group.
22. Rehabilitation Care Consultants. Evaluation of the
Iowa Outcome-Oriented Survey Process.
23. U.S. Department of Health and Human Services. 1983.
Inventory of Surveyors of Medicare and Medicaid
Programs, United States, 1983. Health Care Financing
Administration, Health Standards and Quality Bureau.
Unpublished, Baltimore, Maryland.
24. Association of Health Facility Licensure and
Certification Agency Directors. October 1983. Summary
Report: Licensure and Certification Operations.
U.S. Department of Health and Human Services. 1980.
Proceedings of Symposium on Integration of Health and
Safety Survey and Inspection of Care Review. Health
Standards and Quality Bureau, Baltimore, Maryland.
26. U.S. Department of Health and Human Services. May
1984. Inspection of Care Report. Health Care
OCR for page 233
NOTES / 233
Financing Administration, Health Standards anti
Quality Bureau. Baltimore, Maryland.
27. U.S. Department of Health and Human Services. 1981.
Unpublished data from research in progress. Health
Care Financing Administration, Office of Research and
Demonstrations. Washington, D.C.
28. Health Care Financing Administration, Medicare
Medicaid Automated Certification System. 1981.
Unpublished analysis.
CHAPTER 5
1. Institute of Medicine, Committee on Nursing Home
Regulation. December 1984. Case Studies of Nursing
Home Regulation in Six States. Unpublished Reports.
2. National Association of Attorneys General. February
1978. Enforcing Quality of Care in Nursing Homes.
Committee on the Office of Attorney General.
U.S. Senate. February 9, 1970. Medicare and Medicaid.:
Problems, Issues, and Alternatives. Report of the
staff to the Senate Committee on Finance, 91st
Congress, 2d Session. Committee print.
4. Health Care Financing Administration. 1981. Provider
Certification State Operations Manual. Unpublished
manual.
5. U.S. Department of Health and Human Services. 1984.
Survey and Certification National Review. Unpublished
Briefing Materials. Health Standards and Quality
Bureau, Health Care Financing Administration.
6. Casper, S. K., and R. E. Burke. February 1985. Policy
Recommendations for the Survey Process. Prepared for
the Institute of Medicine Committee on Nursing Home
Regulation.
7. Jost, Timothy S. December 1984. Enforcement of
Quality Nursing Home Care in the Legal System.
Prepared for the Institute of Medicine Committee on
Nursing Home Regulation.
8. Mathematica Policy Research, Inc. January 1985.
Evaluation of the State Demonstrations in Nursing
Home Quality Assurance Processes. Final report.
3.
OCR for page 234
234 / NOTES
9. Institute of Medicine. 1984. Survey of State Health
Facility Licensure and Certification Agency. (See
Appendix C for a report on the survey.)
10. Data from Medicare Medicaid Automated Certification
System on terminations during fiscal years 1983 and
1984. 1983-1984. Health Care Financing
Administration, Health Standards and Quality Bureau.
11. U.S. Fecleral Register. February 21, 1985.
Medicare and Medicaid Programs: Intermediate
Sanction of Long-Term Care Facilities.
50(35):7 1 9 1 -7 1 98.
12. Association of Health Facility Licensure and
Certification Agency Directors. 1983. Licensure and
Certification Directors. Unpublished summary report.
13. Minnesota General Statutes. 1982. Nursing Homes,
section 1 44A.0 1
14. Johnson, Sandra H. January 7, 1985. Evaluation of the
Use of Intermediate Sanctions by the States and
Recommendations for State and Federal Enforcement
Policies. Prepared for the Institute of Medicine
Committee on Nursing Home Regulation.
CHAPTER 6
1. Holder, E. L., and B. W. Frank. December 1984.
Resident Participation in Nursing Homes: A Key to
the Improvement of Life in Nursing Homes and
Improvement in the Nursing Home Regulatory System.
Prepared for Institute of Medicine conference.
2. Institute of Medicine, Committee on Nursing Home
Regulation, Public Meetings. October-December 1984.
3. Institute of Medicine, Committee on Nursing Home
Regulation. 1985. Survey of State Licensure and
Certification Directors. (Appendix C contains a
summary of the findings of this survey.)
4. U.S. Department of Health, Education, and Welfares
Administration on Aging. May 1975. Program
Instruction 75-30.
U.S. Congress. 1985. Older American's Act of 1965,
as amended in 1984. Washington, D.C.: U.S.
Government Printing Office.
OCR for page 235
NOTES/235
6. Testimony before House Select Committee on Aging,
Committee on Human Services. September 10, 1985.
7. Buford, A. D. 1984. Advocacy for the Nursing Home
Resident: An Examination of the Ombudsman Function
and Its Relationship to Licensing and Certification
Activities in Ensuring Quality of Care. Prepared for
the Institute of Medicine Conference on Nursing Home
Regulation.
S. Institute of Medicine, Committee on Nursing Home
Regulation. 1984. Consumer Workshop.
9. Meeting of State Long-Term Care Ombudsmen,
Philadelphia, Pennsylvania, November 1984.
10. Kosberg, J. I. October 1984. Advocacy Organizations
for Nursing Home Residents: A National Study.
11. U.S. Department of Health, Education, and Welfare,
National Center for Health Statistics, July 1979.
National Nursing Home Survey: 1977 Summary for the
United States. HEW Pub. No. 79-1794.
12. U.S. Office of Management and Budget. April 27, 1984.
Circular 1-12: Cost Principles for Non-Profit
Organizations; Lobbying Revision, Federal Register
49(83): 18260- 18277.
13. Zischka, P. C., and I. Jones. February 1984.
Volunteer Community Representatives as Ombudsmen for
the Elderly in Long-Term Care Facilities. The
Gerontologist 24(1):9- 15.
14. Barney, Jane L. March 1974. Community Presence as a
Key to Quality of Life in Nursing Homes. American
Journal of Public Health 64~3~:265-268.
Dobrof, Rose. December, 1984. Community Involvement:
An Approach to Enhancement of Quality of Life in
Nursing Homes. Unpublished paper prepared for
Institute of Medicine Committee on Nursing Home
Regulation.
16. Zwick, Daniel. November 1984. The HCFA Proposal to
Accord "Deemed States" to Nursing Homes Accredited
by JCAH. Unpublished paper prepared for the
Institute of Medicine Committee on Nursing Home
Regulation.
17. Weisfeld, N. 1984. Accreditation, Certification, and
Licensure of Nursing Home Personnel: A Discussion of
Issues and Trends. Unpublished paper.
OCR for page 236
236 / NOTES
18. Aiken, L. H., M. Mezey, J. Lynaugh, and C. Buck.
March 1985. Teaching Nursing Homes: Prospects for
Improving Long-Term Care. Journal of the American
Geriatrics Society 33~3~:196-201.
19. Pattee, J. December 1984. Physicians Serving Nursing
Homes. Unpublished paper prepared for Institute of
Medicine Committee on Nursing Home Regulation.
20. Adams, Carl, and Julia Powell. 1980. Patient
Assessment Computerized. National Health Corporation.
Murfreesboro, Tennessee.
21. Gustafson, D. H., and D. Zimmerman. December 1984.
The Potential for Incentives to Improve Quality of
Care in Nursing Homes. Prepared for Institute of
Medicine Committee on Nursing Home Regulation.
22. Institute of Medicine, Committee on Nursing Home
Regulation. 1984. Report on Management Workshop.
23. Association of Health Facility Licensure and
Certification Directors. 1983 Survey.
CHAPTER 7
1. In Rhode Island, the state licensure and
certification agency obtained voluntary agreement
from all nursing home operators to maintain
up-to-date standard resident assessment data on all
residents. These data were to be used by state
surveyors for sampling purposes in testing the new
Health Care Financing Administration PaCS survey
instrument. Although it was not suggested by the
state agency, about half of the nursing homes
immediately began entering the data into their own
computers and offered to transmit it by telephone to
the regulatory agency to facilitate sampling by the
surveyors.
2. Urban Systems Research and Engineering, Inc. 1984.
Short-Term Evaluation of Medicaid: Selected Issues.
Unpublished Report. Cambridge, Massachusetts.
U.S. General Accounting Office. October 1983.
Medicaid and Nursing Home Care: Cost Increases and
the Need for Services Are Creating Problems for the
States and the Elderly.
3.
OCR for page 237
NOTES / 237
4. Levit, K.R., H. Lazenby, D. R. Waldo, and L. M.
Davidolf. Fall 1985. National Health Expenditures,
1 984. Health Care Financing Review 7~1~:20.
5. Schlenker, R. 1984. Nursing Home Reimbursement,
6.
Quality, and Access--A Synthesis of Research. Paper
commissioned by Institute of Medicine.
Texas is a major exception. It has statewide
occupancy rates below 85 percent, although this is
not true in a couple of the larger cities. Texas also
pays among the lowest Medicaid nursing home rates in
the country.
7. Bayo F., and J. Fabler. 1980. United States
Population Projections for OASDI Cost Estimates,
1980. Social Security Administration, Office of the
Actuary: Actuarial Study No. 82, SSA Pub. No.
11-11529.
S. Morris, J. M., S. Morris, and S. Sherwood. 1984.
Assessment of Informal and Formal Support Systems in
High Risk Elderly Populations. Pp. 223-253 in
Functional Assessment in Rehabilitation Medicine.
C. V. Granger and G. E. Gresham (eds.~. Baltimore,
Maryland: Williams and Wilkins.
9. Curtis, R. E., and L. R. Bartlett. 1984. The High
Cost of Long-Term Care Squeezes State Budgets.
Generations 9~1~:22-25.
10. Powell, Julia. 1984. The Systematic Use of Patient
Assessment Data for Managing Nursing Homes. Paper
commissioned by National Academy of
Sciences/Institute of Medicine Committee on Nursing
Home Regulation.
Representative terms from entire chapter:
nursing homes
