The nursing home market and hospital discharge delays.

One way for hospitals to respond to the incentives in Medicare's PPS is to reduce the patients' length of stay by discharging to nursing home care those patients who no longer require hospital care but are not well enough to go home to informal care. In this study, we find that patients experience more discharge delays at hospitals located in areas with few nursing home beds and in states with prospective Medicaid nursing home reimbursement policies. Hospitals with their own nursing home units or swing beds experience earlier discharges, other things being equal. Our findings suggest that some hospitals are at a disadvantage compared with others and that a policy response may be warranted.