Costs for nursing home care have almost doubled since 1990, from $53 billion to $92 billion in 2000. Much of that spending has been financed with public monies. Under the Medicare and Medicaid programs, the federal government financed 39 percent of the nation's nursing home spending in 2000, up from 28 percent in 1990. As federal outlays have grown, Congress has focused attention on the quality of care delivered and the level of staffing in nursing homes. Nursing home expenditures per resident day varied considerably across Ohio, Mississippi, and Washington--the 3 states covered in GAO's survey. Although the total level of spending varied, the average share devoted to resident-care activities, such as nursing care and medical supplies, was relatively stable. The share of spending devoted to buildings and equipment, by comparison, was more variable. Homes in Ohio and Washington that provided more nursing hours per resident day, especially nurses' aide hours, were less likely than homes providing fewer nursing hours to have repeated serious or potentially life-threatening quality problems. However, GAO found no clear relationship between a nursing home's spending per resident day and the number of serious quality problems.
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