The population of residents served by nursing homes has undergone dramatic changes in the past 30 years – including a 15% increase in post-hospital admissions.

That’s a takeaway from a recent study that highlights trends since the 1987 passage of the Omnibus Reconciliation Act, which called for an overhaul to the nursing home quality assurance system. 

The industry has lost 400 facilities since that time, with more operators becoming Medicare and Medicaid certified, linking up with chain operators and embracing not-for-profit care models, the researchers say. Facilities have meanwhile transformed their care to support growing populations, including:

  • Residents who are racial or ethnic minorities
  • Residents admitted for rehabilitative/post-acute care
  • Residents with complex conditions who require assistance with activities of daily living
  • Residents primarily supported by Medicare (the number of those primarily supported by Medicaid has decreased)
  • Residents diagnosed with dementia and psychiatric conditions such as schizophrenia

Quality improvements have accompanied these shifts, the authors added. This includes a dramatic drop in the number of residents who are physically restrained (from 19% to 1%), and a decrease in inappropriate antipsychotic use (from 16% in 2000 to 12% in 2015). However, there’s been little change in the proportion of facilities cited for medication errors.

Operators are performing admirably in a complex clinical landscape, concluded Shekinah A. Fashaw, MSPH, and colleagues from Brown University. “[I]t is important to note that despite an increasingly vulnerable and higher-need population, we still observe quality gains among nursing homes during this time period,” the authors said.

The study, Thirty-Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act, was published in JAMDA.