Regional Environment and Correlates of Nursing Facilities Closures in Taiwan

Abstract

Abstract Background: Closing nursing facilities profoundly influences the lives of current residents and access for future residents, yet data are limited on whether regional factors impact the closures of nursing facilities. This study examines the factors associated with closure of nursing facilities in Taiwan, including regional factors (e.g., location of the institution, medical accessibility, bed cost and property price), government regulations (e.g., competent authority, institutional appraisal grade and subsidies) and individual institutional factors (e.g., institutional attributes, managers’ backgrounds). Methods: We investigated 199 nursing facilities in two neighboring cities with different population densities, property price and medical resources from 2011 to 2019, analyzed their survival probabilities, and explored the risk factors via survival analysis. Results: For every increase of US$333 in property price per Taiwanese ping [3.305 m2], the hazard ratio was equal to 1.009. Also, institutions in metropolitan areas were less likely to close (hazard ratio, 0.313). Secondly, institutions with lower appraisal levels were more likely to be closed (hazard ratio, 4.874). Finally, operator background, institutional type and bed occupancy were important individual institutional factors related to closure. Conclusion: Our results suggest that regional factors affect the continued operation of nursing facilities. Institutional operators who rent are easily affected by property price fluctuation, but it is difficult to directly reflect the rent cost on the charges of residents and adjust it according to market fluctuations at any time. Additionally, operating in low-population-density areas proves problematic. Furthermore, people living in non-metropolitan areas use institutional resources accessibility issues need awareness. Our findings show that the government should pay more attention to the risk factors of nursing home closures. We also recommend that the supervising authorities of nursing facilities include these items as part of their regular data collection, examine the relationships between risk factors, observe the impact of regional factors such as population density, the number of institutions, and property prices in the region on institutions, and establish an early warning system.