Cross-state variation in conceptions of quality of nursing facility long-term care for the elderly

We address two issues in this exploratory study. First, to what degree do variables prominent in explaining cross-state variation in the generosity of other public assistance programs also help to explain the resources states devote to nursing facility long-term care for the elderly, a service supported largely by states' Medicaid programs? Second, to what degree do the resources that states commit to this purpose influence the quality of state nursing facility processes and, in turn, translate into state nursing facility residents' quality-of-life outcomes? We find unusual features to the pattern of factors explaining state resource levels. We also find surprises in relations among the three aspects of quality, but overall, raising resource adequacy improves nursing facility process quality, which, in turn, bolsters nursing facility residents' quality-of-life outcomes. We close with suggestions for further improvement.