Mary Jane Koren

Modern Healthcare’s August 16 issue features a commentary on the many ways that consistent assignment benefits nursing homes and residents, written by Mary Jane Koren, M.D., M.P.H., chair of the Advancing Excellence in America’s Nursing Homes campaign.

Koren, a geriatrician and vice president at The Commonwealth Fund, explains in “Predictable Scheduling: Nursing Homes Can Boost Quality, Bottom Line with ‘Consistent Assignment’” that when a nurse aide routinely cares for a nursing home resident, it improves the quality of care and is cost-effective.

Relationship between Consistent Assignment and Quality

Consistent assignment is one of the targets identified by Advancing Excellence in America’s Nursing Homes, a national campaign to improve the quality of nursing home care. Participating nursing homes set quality targets, and the campaign provides tools to measure progress and achieve goals.

The campaign data shows that nursing homes that have made inroads in improving quality outcomes are often facilities “with low staff turnover and…rely on consistent assignment,” Koren writes.

For example, she explains that when an aide develops a relationship with a resident through consistent assignment, the use of physical restraints can decrease and the development of pressure ulcers can be reduced. Ongoing relationships allow aides to observe and report potential medical problems, thus reducing costs.

Since residents rate relationships with caregivers as important, Koren says that nursing homes that employ consistent assignment have a “competitive edge in a tough market.”

“The PHI team has coached many nursing homes to implement consistent assignment,” said PHI Director of Training and Organizational Development Services Susan Misiorski.

“I can’t emphasize enough how critical this practice is to ensuring high job satisfaction, high resident satisfaction, and quality care outcomes,” Misiorski said.

Case Study on Consistent Assignment

Consistent assignment is one of the practices featured in a recently published PHI case study that highlights the outcomes achieved by the Edgewood Centre in Portsmouth, NH.

– by Deane Beebe

Over the last several weeks, direct-care workers have received attention in the press.

Newsday Op-Ed

Newsday published an op-ed (pdf) co-written by PHI President Steven Dawson and Direct Care Alliance Executive Director Leonila Vega to pay tribute to the “American heroine” Evelyn Coke on the one-year anniversary of her death.

Coke, a home care worker, fought the Fair Labor Standards Act’s “companionship exemption.”

“In honor of Coke and the millions of home care workers nationwide, Secretary of Labor Hilda Solis should immediately provide all home care workers with the minimum wage and overtime protections promised to American workers under the Fair Labor Standards Act,” wrote Dawson and Vega.

New York Times Blog Posts

The New York Times reports in its New Old Age Blog on the relationship between quality care in nursing homes and high turnover of nurses’ aides.

Reporter Dale Russakoff shares her personal experience with finding a nursing home for her mother 10 years ago. She writes that what has changed since then is that “the federal government and the states have all identified the turnover rate as a crisis in long-term care.”

PHI Director of Curriculum and Workforce Development Peggy Powell confirms Russakoff’s observations and is quoted as saying, “Cycling in aides who don’t know you is very disorienting and upsetting, and the resident is the one who suffers on the quality end.”

In another New York Times blog post, Nancy Folbre, an economics professor at the University of Massachusetts Amherst, argues for creating more jobs by providing increased federal support for home care services and cites two reports to make her case.

More Media Coverage

More news on the direct-care workforce, including a letter (pdf) to the editor published in the Boston Globe on how Massachusetts health care reform left direct-care workers behind, can be found at the PHI Newsroom.

– by Deane Beebe

Penalties paid by nursing homes that violate Medicare regulations could be redirected to fund advanced training programs for direct-care workers, if regulations proposed by the Centers for Medicare and Medicaid Services (CMS) are implemented.

These are the first regulations to be proposed as part of the nursing home transparency provisions of the Affordable Care Act.

CMS is requesting comments by August 11 on this, and other, proposed regulations related to civil monetary penalties (CMPs). Nursing homes pay CMPs when they violate Medicare and/or Medicaid quality-of-care requirements.

Instructions for filing comments can be found in the July 12 edition of the Federal Register (pdf).

Distributing CMP Funds

Monetary penalties collected from facilities that violate Medicaid regulations go into government coffers to be spent on programs that “directly benefit facility residents.” Since 2002, direct-care worker training programs have been included within that category.

CMP funds derived from Medicare violations, meanwhile, are redirected to the U.S. Treasury, and are added to general revenues.

CMS is now proposing to use half of the CMP money garnered from Medicare penalties to support activities that benefit facility residents.

“The Affordable Care Act’s provisions are a welcome recognition that all CMPs ought to be put back into programs to benefit the residents,” said Hollis Turnham, PHI Midwest director. “I’m hopeful that once the regulations are finalized, CMS will have new resources to serve residents, including enhancing the skills of frontline staff.”

Past Uses of CMP Funds

In the past, funds from nursing home Medicaid violations have been used to fund many different kinds of programs pertaining to direct-care workers.

For example, Indiana has used CMP funds to pay for advanced dementia training. Meanwhile, North Carolina funded instruction for PHI Coaching Supervision^SM training with CMP money. And, a program in Kansas helped subsidize a skill-improvement training for direct-care workers there.

Other Proposals

CMS has issued several other proposals on how to modify the CMP collection system:

• CMP funds will be placed in an escrow account if the facility decides to formally appeal the penalty.
• An independent informal dispute resolution process will be created to foster greater transparency in the appeal process.
• Facilities that self-report violations and quickly work to correct them can see a reduction in their CMP of up to 50 percent.

– by Matthew Ozga

The National Citizens’ Coalition for Nursing Home Reform (NCCNHR) has changed its name, reorganized, and expanded its national advocacy priorities. Read the full story

A CNA assists a resident at Genesis HealthCare

For employers seeking to improve quality of care by improving the quality of direct-care jobs, PHI has created a new resource at its website: profiles of “best practices” employed in nursing homes and home and community-based settings. Read the full story

Nurses interested in promoting and sustaining person-directed care and culture change in nursing homes now have a new resource called “Nurse Competencies for Nursing Home Culture Change” (pdf), which identifies specific skills that nurses need to develop to make changes. Read the full story