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Am J Public Health. 2013 May;103(5):e31-7. doi: 10.2105/AJPH.2013.301243. Epub 2013 Mar 14.

Making difficult decisions: the role of quality of care in choosing a nursing home.

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  • 1School of Nursing, University of Rochester, Rochester, NY 14642, USA.



We investigated how quality of care affects choosing a nursing home.


We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model.


In all states, consumers were more likely to choose nursing homes of high hotel services quality but not clinical care quality. Nursing home choice was also significantly associated with shorter distance from prior residence, not-for-profit status, and larger facility size.


In the absence of quality report cards, consumers choose a nursing home on the basis of the quality dimensions that are easy for them to observe, evaluate, and apply to their situation. Future research should focus on identifying the quality information that offers the most value added to consumers.

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