Nursing Home Deficiencies in the United States

This is a confirmatory factor analysis (CFA) of deficiencies in nursing homes obtained from the On-line Survey Certification and Reporting system (OSCAR), a national database on nursing home quality maintained by the U.S. Health Care Financing Administration (HCFA). A major goal was to identify a core set of items that would reliably reflect a meaningful set of dimensions of problems in quality of care. The analysis suggests that it is reasonable to posit a model of eight underlying factors to which state surveyors are responding as they assign deficiencies to nursing homes. Forty items are robust indicators of the eight dimensions of problems in quality of care. The data contain considerable random and probably systematic error worth understanding. Establishing that the data contain systematic variability is crucial because OSCAR data are a potentially valuable source of quality of care information for researchers, policymakers, and consumers.