"Driven to Tiers: Evidence and Implications of
a Two-tiered System of Nursing Home Care"
12:00 - 1:30 PM
Colonial Penn Center Auditorium
(co-sponsored by The RAND/Hartford Center for Interdisciplinary Geriatric
Health Care Research, University of Pennsylvania)
There is a long history of quality problems in US nursing homes, resistant
to reform in spite of numerous regulatory initiatives, increases in funding
and mandates for increased staffing. While the public perception is that
of a uniformly poor quality industry, it has been frequently noted that
a small proportion of nursing facilities across the country manifest most
of the problems. However, to date the stratification of the industry into
homes unable to meet resident needs and those facilities providing adequate,
or even excellent care, has not been fully examined. In this paper we provide
evidence for a two-tiered system of nursing home care, stratified on the
basis of the number, type and quality of services provided. Our research
indicates that this is a long-standing feature of the nursing home industry,
and that recent market and regulatory events have reinforced stratification.
As important, our study documents the transformation of the nursing home
industry and uncovers highly suggestive evidence that the poor and frail
residents served by the providers left behind are at risk for receiving
Dr. Zinn is an associate professor and director of the program in Healthcare
Management, Department of Risk, Insurance and Healthcare Management, Fox
School of Business and Management at Temple University, Philadelphia PA.
She teaches strategic management and health care administration. Her research
has examined the influence of market competition on quality and access
in hospitals, nursing homes and home health agencies. She has investigated
the association between organizational characteristics and quality in
health care settings, comparing severity-adjusted outcomes of care. In
the field of laboratory medicine, she has explored the application of
various consensus development techniques to evaluate laboratory performance.
She is the 1996 recipient of the John D. Thompson Prize for research achievement,
and is a 1997 co-recipient of a Robert Wood Johnson Clinical Investigator
Award. Dr. Zinn is an adjunct fellow of the Leonard Davis Institute for
Health Economics and a Fellow at the Institute on Aging, University of
Pennsylvania. She is a past chair of the Healthcare Management Division
of the Academy of Management. She served as director of the Doctoral Program
in Healthcare Management from 1994-2000, and has personally chaired or
advised on over twenty dissertations in the fields of international strategy,
healthcare systems, and public health.