Predictors of California nursing facilities' acceptance of people with HIV/AIDS

To examine factors that might predict the provision of HIV/AIDS care among California nursing facilities (NFs) in 1990.

Logistic regression to examine the probability that a NF had admitted a person with AIDS/HIV (PWA/H). Independent variables of key interest included whether the facility was hospital-based; whether it sustained a financial loss in FY 1990; whether it had a hospice; the percentage of its residents on Medicare; the percentage of its residents on MediCal; the number of PWA/Hs per elderly in the county where the facility was located; the ratio of home-based hospices to elderly in the county; and the ratio of NF beds to elderly in the county.

Data on all California NFs, obtained from the Office of Statewide Health Planning and Development (OSHPD), were merged with state data on the cumulative incidence of AIDS cases by county; U.S. census data on the number of elderly by county; and home-based hospice data from the 1990 Case Management Resource Guide for California.

Of the 902 facilities examined, 7.65 percent served AIDS residents. The financial loss variable was not significant. The community-based hospice variable was significant and negative. All other key variables were significant and positive.

This study (1) suggests that NFs respond to external pressures to provide AIDS care even in the absence of financial incentives or a positive financial margin; (2) supports concerns that competition may exist between the elderly and PWA/H for NF beds; (3) shows that NFs are less likely to provide care if substitute services are available; and (4) demonstrates that facilities capable of providing a higher level of clinical and psychosocial care may be particularly willing, perhaps able, to provide AIDS care.