The State of Quality
The commitment to quality in our nation’s long term and post-acute care facilities has never been greater. From the growth in AHCA/NCAL’s National Quality Award Program and participation in programs such as Advancing Excellence in America’s Nursing Homes, providers across the country are embracing the quality movement.
Data released in the third annual Quality Report, compiled in part by AHCA to illustrate the positive trends in quality improvement, found measurable improvements in 9 out of 10 quality measures since 2009. Additionally, nursing facilities have improved in all short-stay measures, which include patient delirium, pain and pressure ulcers, and a vast majority of long-stay measures including measureable improvements in activities of daily living (ADL), high-risk pressure ulcers, resident mobility and pain.
As we look at 2012, AHCA’s new department of Quality, led by Dr. David Gifford, MPH, is focusing on the importance of quality for each and every member facility. Joining national government leaders in the Partnership for Patients initiative brought AHCA to the table with stakeholders throughout the nation. Early 2012 will find the launch of a new AHCA/NCAL Quality Initiative, which will focus on four major topic areas – rehospitalizations, anti-psychotic medication, improving staff stability and improving resident satisfaction.
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The State of Reimbursement
The financing systems upon which this profession is dependent – Medicare and Medicaid – affects all areas of the profession and is often unstable. From the high quality care we deliver every day to the career training we provide, funding and payment systems play a vital role in the sustainability of nursing facilities and assisted living residences. In considering the state of reimbursement for nursing care centers in 2012, there has never been a more critical time to ensure a stable and consistent funding system for the patients and residents we care for each day.
Medicare – a significant funding source for long term and post-acute care – reimburses providers through a prospective payment system based on categories called Resource Utilization Groups (RUGs), which reflect a patient’s clinical and rehabilitative care needs. On average, Medicare beneficiaries return home or to the community after a relatively short rehabilitative stay of 36 ½ days in a skilled nursing facility (SNF).
Over the last year, Medicare payments to skilled nursing facilities have been severely affected. An 11.1 percent reduction in Medicare funding earlier in the year threatens access to the quality care we provide every day. Recent Congressional proposals have suggested reducing Medicare bad debt coverage to SNFs from 100 percent to 55 percent by 2015, a move that would have a severe and adverse effect on facilities across the country.
Medicaid – the largest payer of long term care and services – covers 64 percent of nursing home patients and 19 percent of assisted living residents each day. Medicaid’s daily rate covers 24-hour nursing care; housing; meals and dietary supplements; beds; lifts; wheelchairs and medical supplies; social activities and personal care services.
A blend of both federal and state dollars paid at a rate set by each state, Medicaid reimbursement often fails to cover the actual cost of providing care. A recent report conducted by Eljay estimates that the national Medicaid shortfall for skilled nursing care in 2011 was $6.3 billion – or nearly $20 per patient, per day.
AHCA/NCAL and our members will spend 2012 working directly with Congress, state lawmakers and other stakeholders to ensure that continued and stable funding – which is so very critical to providing the care our nation needs – is available for every provider.
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The State of Assisted Living
As an integral part of the care continuum, assisted living is a dynamic form of care, serving primarily elderly people and individuals with disabilities. With the average age of residents at approximately 87 years, more than 42 percent of residents have a diagnosis of Alzheimer’s disease or another form of dementia.
The National Center for Assisted Living’s (NCAL) mission is to lead the assisted living profession through public policy advocacy, knowledge, education, and professional development. Dedicated to promoting high quality, principle-driven assisted living care and services with a steadfast commitment to excellence, innovation and the advancement of person-centered care, NCAL is focused on continuously improving upon the care and services delivered to seniors.
An essential focus in 2012 will be fighting to ensure that low income seniors keep assisted living as an option under Medicaid Waiver programs. NCAL is also committed to managing the risks that come with caring for a frail elderly population by focusing on the topic of risk during NCAL’s Spring Conference.
Throughout the year, NCAL advocates will tell their assisted living story on Capitol Hill through the annual Congressional Briefing and targeted fly-ins. NCAL is also focused on assisted living being included in the electronic health records initiative.
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The State of Post-Acute Care
Over the course of the last decade, the integration of post-acute care services in America’s skilled nursing and rehabilitation facilities has changed the healthcare delivery system. Without a doubt, the state of post-acute care in nursing facilities is evolving as facilities continue to treat more short-stay patients and provide intensive medical care for patients requiring a greater variety of complex care services.
Unlike nursing homes of the past that served primarily as long term care settings, the 21st century nursing home provides patients with a myriad of services including medical, rehabilitative and therapeutic care. In previous years, patients would have to remain in the hospital following life-saving surgery, medical complications or a serious accident. Today, patients are turning to free-standing nursing and rehabilitation facilities to provide the multifaceted post-acute care they require.
In the years ahead, our role in the delivery of post-acute care will continue to evolve, and likely expand. Trends suggest that we will admit more and more patients following a hospital visit; provide them with specialized care; and send them home – and we are prepared to do so.
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