A study released this week (pdf 783k) by federal investigators reports 90 percent of nursing homes were cited last year for violations of federal health and safety standards. For-profit homes were more likely to have problems than other types of nursing homes.
Problems found across the country ranged from bedsores to poor nutrition. The Department of Health and Human Services said there were cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”
Quality of Care Linked to Staffing / Jobs
As usual, the issue of quality care comes down to quality staffing. In response to the federal government report on nursing home violations, Larry Minnix, president and C.E.O. of the American Association of Homes and Services for the Aging, told Jane Gross of The New Old Age blog, “If you’re touring a long-term care facility, you can and should ask about their staff turnover rate. Staffing is the best proxy for quality, and I predict it will be one of the hottest issues as we prepare to meet the needs of the baby boom generation.”
PHI agrees. Residents repeatedly tell researchers that what matters most to their quality of life is their relationship with the direct-care workers who support them. Those relationships are best when organizations value their direct-care workers and provide quality jobs. That’s why PHI’s national policy agenda (pdf) supports state contracting standards and reimbursement methods that reward employers for investing in quality jobs and showing positive outcomes such as reduced turnover.
Aaron Toleos, Online Communications Director
atoleos@phinational.org
Dear PHI Editor,
Consistent, well trained staff are a key ingredient in the provision of quality care – that is without question. Two things concern me about this article, however. First, the survey process is subjective not objective, and applied differently in each state, in each region of the state, and certainly by individual surveyors – and this is mentioned in the original report. The standard in any nursing home survey is perfection, which humans will never achieve, although we all strive toward that goal. A citation of harm can be as simple as an individual getting a small blister from new shoes when beginning therapy – which results in a pressure sore citation at a G level – even if the shoes were immediately replaced. How many sports teams could pass this standard? Great strides have been made toward providing excellent care in nursing homes – just look at the outcomes of the Advancing Excellence Campaign. In the last 10+ years the survey process has become progressively more stringent. Reporting that an increasing number of facilities are being cited gives the impression that care has not improved, when in fact it has greatly improved, but the system has changed. Data comparison is not valid when the system used at the time it was collected was not consistently the same.
Secondly, the graph is displayed in a way that makes the for-profit facilities stand out more than they would if all scores were displayed on a 0% to 100% grid. The grid only has a span of 14%, and when one realizes that, it is evident that it makes for a sensational, misleading, and clearly inaccurate visual display. The actual difference is a span from 3% to 7% between for-profit, government, and non-profit homes. Nowhere does the graph show the scope and severity level of the citations, although the original report states that levels of harm are most commonly cited at an isolated level in recent years, rather than the previous ‘pattern or widespread’ levels.
At times there are negative outcomes in care, and that is why Quality Assurance and Improvement is intended to have a prominent place in operations of any nursing home. If a facility consistently delivers poor care, that should be addressed by the state survey team, but we should also acknowledge the reality that most facilities do a good job.
Thank you to all who dedicate their careers to caring for those unable to care for themselves.
Betty MacLaughlin Frandsen RN, NHA