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Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

We examine the influences of African-American and female legislators on the supportiveness of states toward elders. Previous research shows complementary supportiveness among women and minority legislators on education policy and a range of social policies affecting families. Women legislators extend this support to various dimensions of “state age friendliness.” We examine here whether African-American legislators extend their support similarly. We draw on a cross-sectional data set for the 50 American states around the year 2000 in conjunction with regression. We find that, controlling for the most prominent alternative factors generally shaping state orientations and policies, women legislators are selectively supportive of dimensions of state elderly friendliness, but African-American legislators do not share this support. We attribute the discrepancy in the support of this area of social policy to women and minority legislators having specific divergent priorities with regard to elders as well as to how these priorities are conditioned by women and black legislators being concentrated in different states having distinctive cultures.

Nursing facility inspections routinely produce statistics revealing sharp disparities in care at both the facility and the state level. But whether high rates of deficiencies are more indicative of stringent enforcement of standards, leading to improved care, or ongoing poor quality care remains unclear. Until this question is answered, families of nursing facility residents, responsible public officials and interested professionals, are all unable to make sound decisions about long-term care quality. We employ cross-sectional, panel data to compare states on multiple indices of both care quality and enforcement stringency. We use the multi-method-multi-trait approach to distinguish these concepts. We find that low rates of deficiencies are positively associated with independent measures of high quality care. But, a prominent nursing facility enforcement index likely registers poor quality care more than stringency of enforcement since it is associated positively with independent indices of poor quality care and negatively with independent measures of enforcement. Attentive publics can have reasonable confidence that low rates of deficiencies indicate high quality care. High rates tend to reflect glaring deterioration in care quality. They are less signals of stringent enforcement than of obviously poor care which prompts more visible enforcement activities. Sadly, there is little evidence suggesting that these enforcement measures improve state-level care quality and thus reduce cross-state disparities in the quality of nursing facility long-term care. However, at least some of the factors responsible for sharp disparities in nursing facility care lie within the capacity of states to rectify even in the short term.

The “baby-boom” generation is poised for retirement. Yet the American states exhibit sharp inequalities in the public support they provide for nursing facility long-term care for the elderly, a form of health care that few Americans can afford to purchase privately. Further, remarkable disparities exist, both within and among states, in the quality of nursing facility care. We describe cross-state variation in Medicaid support for and the quality of nursing facility care, offer regression models that provisionally explain the sources of these inequalities, comment on the social implications of these disparities and recommend a solution.

This chapter provides both an introduction to the volume and a brief review of literature on technology, communications, and health disparities.

Literature review.

The chapter argues for the importance of greater examination of technology, communications, and their linkages to health disparities and other related factors.

Reviews the topic of technology, communication, and health disparities and previews this book.

This chapter will initially review some health care system issues with a focus on the US health care system. It will then review some of the sociological literature about race/ethnicity, immigration, socioeconomic status (SES) and gender and how these factors link to health and health care. In addition, the chapter will serve as an introduction to the volume and will briefly review the contents of the other sections and chapters in this volume.