Braun Robert Tyler, Rosenkranz David, Fernandez Rahul, Stevenson David G, Grabowski David C, Williams Dunc, Jimenez Luz, Bowblis John
Division of Health Policy and Economics, Weill Cornell Medical College, New York, NY, USA.
Department of Economics, Fordham University, New York, NY, USA.
J Am Med Dir Assoc. 2025 Jul;26(7):105630. doi: 10.1016/j.jamda.2025.105630. Epub 2025 May 24.
Many nursing homes require significant modernization to enhance resident quality of life, yet access to capital remains a critical barrier, especially for those dependent on Medicaid funding. The Housing and Urban Development (HUD) 232-sponsored loan program helps insure low-interest financing to nursing homes, but its impact on capital accessibility and quality improvement remains unclear. This study examines nursing home characteristics associated with receiving HUD 232-sponsored loans.
Linear probability model to assess facility, resident, financial, and county-level characteristics predicting HUD 232 loan likelihood.
We analyzed nursing homes from 2012 to 2021, with the HUD 232 cohort spanning 2013 to 2020, using a comprehensive data set combining HUD 232-sponsored loan data, CMS Nursing Home Compare, LTCFocus, and Medicare Cost Reports.
We used a linear probability model to evaluate the relationship between facility characteristics and the likelihood of receiving a HUD 232-sponsored loan, focusing on factors such as ownership type, financial stability, staffing levels, and resident demographics.
Nursing homes with higher operating margins, higher proportions of Medicare residents, and in rural locations were significantly more likely to receive HUD 232-sponsored loans (P < .01). In contrast, not-for-profits were underrepresented among loan recipients (P < .01). There was no significant association between quality measures, such as overall star ratings and health deficiencies, and loan uptake.
The findings suggest that although the HUD 232-sponsored loan program improves access to capital for financially stable nursing homes, it may exclude others in need of funding, such as not-for-profits and nursing homes serving fewer Medicare residents. Policy makers should consider reforms to better align the program with its goal of supporting modernization across the entire nursing home sector, particularly for those facilities that are financially disadvantaged.
许多养老院需要进行重大现代化改造以提高居民生活质量，但获得资金仍然是一个关键障碍，尤其是对于那些依赖医疗补助资金的养老院而言。美国住房和城市发展部（HUD）的232号赞助贷款计划有助于为养老院提供低息融资保险，但其对资金可及性和质量改善的影响仍不明确。本研究考察了与获得HUD 232号赞助贷款相关的养老院特征。
采用线性概率模型评估预测HUD 232号贷款可能性的机构、居民、财务和县级特征。
我们分析了2012年至2021年的养老院，HUD 232队列涵盖2013年至2020年，使用了一个综合数据集，该数据集结合了HUD 232号赞助贷款数据、医疗保险和医疗补助服务中心（CMS）养老院比较数据、长期护理聚焦数据以及医疗保险成本报告。
我们使用线性概率模型评估机构特征与获得HUD 232号赞助贷款可能性之间的关系，重点关注所有权类型、财务稳定性、人员配备水平和居民人口统计学等因素。
运营利润率较高、医疗保险居民比例较高以及位于农村地区的养老院获得HUD 232号赞助贷款的可能性显著更高（P < 0.01）。相比之下，非营利性养老院在贷款接受者中所占比例较低（P < 0.01）。质量指标，如总体星级评级和健康缺陷，与贷款获取之间没有显著关联。
研究结果表明，尽管HUD 232号赞助贷款计划改善了财务稳定的养老院的资金可及性，但它可能会将其他需要资金的养老院排除在外，例如非营利性养老院和服务医疗保险居民较少的养老院。政策制定者应考虑进行改革，以使该计划更好地与其支持整个养老院行业现代化的目标保持一致，特别是对于那些财务状况不佳的机构。
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