Comments on: Violations Widespread at Nursing Homes http://phinational.org/archives/widespread-nursing-home-violations-suggest-need-to-invest-in-workforce/ PHI works to improve long-term care -- by improving the jobs of home health aides, certified nurse aides, & personal care attendants. Tue, 07 Feb 2012 00:41:13 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Betty MacLaughlin Frandsen http://phinational.org/archives/widespread-nursing-home-violations-suggest-need-to-invest-in-workforce/comment-page-1/#comment-1673 Betty MacLaughlin Frandsen Fri, 03 Oct 2008 19:39:55 +0000 http://phinational.org/archives/widespread-nursing-home-violations-suggest-need-to-invest-in-workforce/#comment-1673 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 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

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