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Item Exploring the Relationship Between Nursing Staff and Family Members' Appraisal of Resident Care in Nursing Homes: The Role of Facility Ownership(MDPI, 45699) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanBackground/Objectives: To address long-standing staffing challenges and elevating care standards in the United States, new legislation will require a minimum of 0.55 h per resident day (HPRD) of registered nurse (RN) care, 2.45 HPRD of certified nursing aide (CNA) care, and a combined total of 3.48 HPRD across any combination of nursing staff. We examine differences in family members? views of care quality between facilities meeting the minimum staffing requirements and those that do not and whether there is any difference in those associations by facility ownership. Methods: This cross-sectional study utilized public data from 218 Medicare and Medicaid-certified nursing facilities in Maryland, collected in 2023. We used regression analyses to examine the association between staffing requirements and quality of care ratings, considering facility ownership status as a potential moderator. Results: Compared to facilities with CNA staffing levels below the cut off, facilities that met the CNA staffing requirement were rated more favorably by family members in overall quality and across the subdomains of staffing, care, activities, and security. In contrast, meeting the RN 0.55 cut off was not associated with family ratings across any quality domain. A facility for-profit status did not moderate the relationship between staffing and family ratings. Conclusions: These results suggest that CNA staff time is a significant driver of care quality and that non-profit facilities may already be closer to meeting new federal requirements. These findings highlight the need for regulations that support the minimum nursing staffing requirements to enhance care quality. Future research should identify the specific factors contributing to higher quality care in non-profit facilities and explore ways to implement these practices in for-profit settings.Item Behavioral, Cognitive, and Functional Risk Factors for Repeat Hospital Episodes Among Medicare?Medicaid Dually Eligible Adults Receiving Long-Term Services and Supports(Sage, 2024-09-26) Fakeye, Oludolapo; Rana, Prashant; Han, Fei; Henderson, Morgan; Stockwell, IanRepeat hospitalizations adversely impact the well-being of adults dually eligible for Medicare and Medicaid in the United States. This study aimed to identify behavioral, cognitive, and functional characteristics associated with the risk of a repeat hospital episode (HE) among the statewide population of dually eligible adults in Maryland receiving long-term services and supports prior to an HE between July 2018 and May 2020. The odds of experiencing a repeat HE within 30 days after an initial HE were positively associated with reporting difficulty with hearing (adjusted odds ratio, AOR: 1.10 [95% confidence interval: 1.02?1.19]), being easily distractible (AOR: 1.09 [1.00?1.18]), being self-injurious (AOR: 1.33 [1.09?1.63]), and exhibiting verbal abuse (AOR: 1.15 [1.02?1.30]). Conversely, displaying inappropriate public behavior (AOR: 0.62 [0.42?0.92]) and being dependent for eating (AOR: 0.91 [0.83?0.99]) or bathing (AOR: 0.79 [0.67?0.92]) were associated with reduced odds of a repeat HE. We also observed differences in the magnitude and direction of these associations among adults 65 years of age or older relative to younger counterparts.Item Behind the Curtain: Comparing Predictive Models Performance in 2 Publicly Insured Populations(Wolters Kluwer Health, 2024-11) Sun, Ruichen; Henderson, Morgan; Goetschius, Leigh; Han, Fei; Stockwell, IanIntroduction: Predictive models have proliferated in the health system in recent years and have been used to predict both health services utilization and medical outcomes. Less is known, however, on how these models function and how they might adapt to different contexts. The purpose of the current study is to shed light on the inner workings of a large-scale predictive model deployed in 2 distinct populations, with a particular emphasis on adaptability issues. Methods: We compared the performance and functioning of a predictive model of avoidable hospitalization in 2 very different populations: Medicaid and Medicare enrollees in Maryland. Specifically, we assessed characteristics of the risk scores from March 2022 for the 2 populations, the predictive ability of the scores, and the driving risk factors behind the scores. In addition, we created and assessed the performance of an “unadapted” model by applying coefficients from the Medicare model to the Medicaid population. Results: The model adapted to, and performed well in, both populations, despite demographic differences in these 2 groups. However, the most salient risk factors and their relative weightings differed, sometimes dramatically, across the 2 populations. The unadapted Medicaid model displayed poor performance relative to the adapted model. Conclusions: Our findings speak to the need to “peek behind the curtain” of predictive models that may be applied to different populations, and we caution that risk prediction is not “one size fits all”: for optimal performance, models should be adapted to, and trained on, the target population.Item Nursing Facility Characteristics Are Differentially Associated With Family Satisfaction and Regulatory Star Ratings(Southern Gerontological Society, 2025-01-08) Millar, Roberto J.; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanResearch suggests that nursing facility structural characteristics are important contributors toward residents’ quality of care. We use 2021 data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings. We used descriptive statistics to explore differences in quality metrics across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and resident census (1–60, 61–120, and 121+). Relationships were examined across overall ratings, as well as across subdomains of the two frameworks (e.g., staffing). Family members of residents in non-profit, rural, and low-census facilities rated facilities higher. Non-profit and low-resident census facilities were more likely to be rated four or five stars, while no significant association was observed across geographic location, or interactions across structural factors. Findings emphasize the need for comprehensive quality-of-care frameworks that explore quality care across stakeholders and types of facilities.Item Mississippi Medicaid Expansion Policy Option Analysis(The Hilltop Institute, 2024-04-10) The Hilltop InstituteAs Mississippi is actively considering expanding its Medicaid program, Hilltop created this informational brief to capture key facts regarding Medicaid policy options as they apply to a potential Medicaid expansion in Mississippi.Item Mississippi Medicaid Expansion and Work Requirements(The Hilltop Institute, 2024-03-13) The Hilltop InstituteAs Mississippi is actively considering expanding its Medicaid program, Hilltop created this informational brief to capture key facts regarding Medicaid work requirements as they apply to a potential Medicaid expansion in Mississippi.Item Medical Day Care Services Waiver Infographic: FY 2019 to FY 2022(The Hilltop Institute, 2024-05-01) The Hilltop InstituteThe Medical Day Care (MDC) Services Waiver provides health, social, and related support services in a community-based setting to functionally disabled adults aged 16 and older. This infographic presents information for fiscal year (FY) 2019 to FY 2022.Item Medicaid Long-Term Services and Supports in Maryland: TheCommunity Pathways Waiver FY2019 to FY2022(The Hilltop Institute, 2024-05-01) The Hilltop InstituteThe Community Pathways Waiver provides community?based services and supports to individuals with developmental or intellectual disabilities. This infographic presents information for fiscal year (FY) 2019 to FY 2022.Item Medicaid Long-Term Services and Supports in Maryland: The Family Supports Waiver FY 2019 to FY 2022(The Hilltop Institute, 2024-05-01) The Hilltop InstituteThe Family Supports Waiver (FSW) provides community-based services and supports to individuals aged 21 years or younger with developmental or intellectual disabilities. This infographic presents information for fiscal year (FY) 2019 to FY 2022.Item Medicaid Long-Term Services and Supports in Maryland: Model Waiver FY 2017 to FY 2021(The Hilltop Institute, 2024-02-01) The Hilltop InstituteThe Model Waiver provides services to individuals with medically complex needs and a chronic hospital or nursing facility level of care to be supported in their own homes or community?based settings. Services covered under the waiver include private duty nursing (PDN) services provided by registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), and home health aides (HHAs). This infographic provides information for fiscal year (FY) 2017 to FY 2021.Item Medicaid Long-Term Services and Supports in Maryland: Home and Community-Based Options Waiver FY 2019 to FY 2022(The Hilltop Institute, 2024-05-24) The Hilltop InstituteThe Home and Community-Based Options Waiver (CO Waiver) provides community-based services and supports that enable older adults and those with physical disabilities to continue living in their own homes or in assisted living facilities. This infographic presents information for fiscal year (FY) 2019 to FY 2022.Item Medicaid Long-Term Services and Supports in Maryland: Medical Day Care Services Waiver FY 2019 to FY 2021(The Hilltop Institute, 2024-02-01) The Hilltop InstituteThe Medical Day Care (MDC) Services Waiver provides health, social, and related support services in a community?based setting to functionally disabled adults aged 16 and older. This infographic presents information for fiscal year (FY) 2019 to FY 2021.Item Annual Report on the Maryland Medical Assistance Program and the Maryland Children’s Health Program – Provider Reimbursement Rates(The Hilltop Institute, 2022-01-01) The Hilltop InstitutePursuant to Maryland Health-General §15-103.5 and Insurance Article §19-807(d)(2), the Maryland Department of Health (MDH) submits an annual report to the Governor and various House and Senate committees addressing the progress of the rate-setting process; a comparison of Maryland Medicaid’s reimbursement rates with those of other states; the schedule for adjusting Maryland’s reimbursement rates; and the estimated costs of implementing the above schedule and proposed changes to the fee-for-service reimbursement rates. This report, dated January 2022, satisfies these requirements for fiscal year 2021.Item Medicaid Long-Term Services and Supports in Maryland: Home and Community-Based Options Waiver FY 2019 to FY 2021(The Hilltop Institute, 2024-02-01) The Hilltop InstituteThe Home and Community?Based Options Waiver (CO Waiver) provides community?based services and supports that enable older adults and those with physical disabilities to continue living in their own homes or in assisted living facilities. This infographic presents information for fiscal year (FY) 2019 to FY 2021.Item Medicaid Long-Term Services and Supports in Maryland: FY 2018 to FY 2022, Nursing Facility Services. A Chart Book.(The Hilltop Institute, 2024-07-02) The Hilltop InstituteItem Medicaid Long-Term Services and Supports in Maryland: Family Supports Waiver FY 2019 to FY 2021(The Hilltop Institute, 2024-02-01) The Hilltop InstituteThe Family Supports Waiver (FSW) provides community-based services and supports to individuals aged 21 years or younger with developmental or intellectual disabilities. This infographic presents information for fiscal year (FY) 2019 to FY 2021.Item Medicaid Long-Term Services and Supports in Maryland: Community Supports Waiver FY 2019 to FY 2022(The Hilltop Institute, 2024-05-01) The Hilltop InstituteThe Community Supports Waiver (CSW) provides community-based services and supports to individuals of all ages with developmental or intellectual disabilities. This infographic presents information for fiscal year (FY) 2019 to FY 2022.Item Medicaid Long-Term Services and Supports in Maryland: Community Supports Waiver FY 2018 to FY 2021(The Hilltop Institute, 2024-02-01) The Hilltop InstituteThe Community Supports Waiver (CSW) provides community-based services and supports to individuals of all ages with developmental or intellectual disabilities. This infographic presents information for fiscal year (FY) 2018 to FY 2021.Item Medicaid Long-Term Services and Supports in Maryland: Community Personal Assistance Service Waiver: FY 2019 to FY 2022(The Hilltop Institute, 2024-05-24) The Hilltop InstituteThe Community Personal Assistance Services (CPAS) program is a state plan program that provides in?home personal assistance services, nurse monitoring, and supports planning to older adults and individuals who need assistance with at least one activity of daily living. This infographic presents information for fiscal year (FY) 2019 to FY 2022.Item Medicaid Long-Term Services and Supports in Maryland: Community Personal Assistance Services Program FY 2019 to FY 2021(The Hilltop Institute, 2024-02-01) The Hilltop InstituteThe Community Personal Assistance Services (CPAS) program is a state plan program that provides in?home personal assistance services, nurse monitoring, and supports planning to older adults and individuals who need assistance with at least one activity of daily living. This infographic presents information for fiscal year (FY) 2019 to FY 2021.