Facility Characteristics Associated With Intensity of Care of Nursing Homes and Hospital Referral Regions.

This was an observational facility-level analysis, so it shows associations, not causes. It cannot prove that a dementia unit, hospice use, pressure ulcers, NP/PA staffing, or the proportion of Black residents changed feeding tube or hospital transfer rates. The data did not include patient preferences, whether preferences were documented, or whether residents and families received accurate information about the likely benefits and harms of feeding tubes and hospital transfers. Facility culture, staff attitudes, and regional market factors were not measured. Nursing homes that were high on one intervention and low on the other were excluded (n=1,383), so the sample included only facilities with concordant high or low intensity on both feeding tubes and hospital transfers. The analysis used aggregated facility rates, not individual resident outcomes, so it cannot describe care for any one resident. The Discussion suggests possible targets, such as dementia units, hospice, palliative care, and provider training, but this analysis did not test whether these change feeding tube or hospital transfer rates.

The study was funded by the National Institutes of Health, and the authors reported no conflicts of interest to disclose.

Do not read these associations as proof that adding a dementia unit, increasing hospice use, reducing pressure ulcers, or changing facility staffing will lower feeding tubes or hospital transfers. The study was observational, used facility-level rates, and did not measure patient preferences, facility culture, staff attitudes, or regional market factors.