Volume 53 | Number 5 | October 2018

Abstract List

Nina R. Joyce Ph.D., Thomas G. McGuire Ph.D., Stephen J. Bartels M.D., Susan L. Mitchell M.D., M.P.H., David C. Grabowski Ph.D.


To compare the quality of care following admission to a nursing home () with and without a dementia special care unit () for residents with dementia.

Data Sources/Study Setting

National resident‐level minimum dataset assessments () 2005–2010 merged with Medicare claims and provider‐level data from the Online Survey, Certification, and Reporting database.

Study Design

We employ an instrumental variable approach to address the endogeneity of selection into an facility controlling for a range of individual‐level covariates. We use “differential distance” to a nursing home with and without an as our instrument.

Data Collection/Extraction Methods

Minimum dataset assessments performed at admission and every quarter thereafter.

Principal Findings

Admission to a facility with an led to a reduction in inappropriate antipsychotics (−9.7 percent), physical restraints (−9.6 percent), pressure ulcers (−3.3 percent), feeding tubes (−8.3 percent), and hospitalizations (−14.7 percent). We found no impact on the use of indwelling urinary catheters. Results held in sensitivity analyses that accounted for the share of beds and the facilities' overall quality.


Facilities with an provide better quality of care as measured by several validated quality indicators. Given the aging population, policies to promote the expansion and use of dementia s may be warranted.