Estimating Selective Admissions in Nursing Homes

This proposal requests funding to analyze the results of a nursing home audit study that we conducted from March to August 2025, investigating the impact of race, payer, and medical condition on admissions inquiries in 3,000 US nursing homes. The preliminary results indicate lower availability for Medicaid compared to private payers, and for patients with memory issues compared to other patients, but no differential availability by race. The current proposal will allow us to (1) investigate heterogeneity in these availability gaps across contexts (such as by nursing home quality; local or facility demographics; the payment gap between Medicaid and private pay; and occupancy rates); (2) embed the results in a model of constrained choice to quantify the role of selective admissions in contributing to observed differences in nursing home attendance patterns; and (3) create public goods to support future high-quality audit studies. The results of the proposed research will greatly aid in our understanding of the role of nursing home admissions practices in contributing to the significant, observed differences in the quality of care received across different groups.