AHCA and the Alliance for Quality Nursing Home Care recently released their 2010 Annual Report on the state of quality care in America’s nursing and rehabilitation centers for the second consecutive year. The report provides a comprehensive and critical analysis of quality trends in long term, post-acute and rehabilitative care by closely examining the evolving role of nursing facilities, recent trends in patient outcomes, the value of person-centered care practices and the impact of community-wide quality initiatives.
Some of the key findings of the report include:
- As nursing facilities treat diverse patients, and in some cases, become more specialized the treat a targeted population, policymakers may consider how to measure quality based on a patients’ needs, rather than setting of care.
- Since 2003, there has been an annual increase in the percentage of Medicare beneficiaries discharged to the community in 100 days. Given the increasing complexity of this population, these numbers suggest the continued ability of nursing facilities to provide therapeutic and rehabilitative services that enable patients to return to their homes.
- More refined quality measures may foster greater consistency in state surveys and inspections as well as better target processes and outcome measure to more accurately reflect the care provided by type of patient.
- Data suggests that nursing facilities represent the lowest-cost institutional setting...indicating that nursing facilities may provide policymakers with an opportunity for shifting high acuity patients to nursing facilities with the goal of lowering program payments.
- Payment rates and quality are also linked, which may reflect the effect of payment levels on the intermediate variable, staffing.
- Hospitalizations and the average number of survey deficiencies by facility, while imperfect metrics, are increasing, while the percentage of facilities cited for substandard quality of care are decreasing.
- The overall trend in resident satisfaction since 2005 has been an increase in satisfaction, indicating that more providers are implementing practices recommended by national quality improvement initiatives.
- Research suggests that person-centered care is associated with improved organizational performance, higher residents and staff satisfaction, better workplace performance and higher occupancy rates.
- To better align financial incentives, reimbursement systems should take into account person centered care practice and/or performance metrics that are sensitive to culture change.
- Voluntary participation in collaborative campaigns, such as Advancing Excellence in America’s Nursing Homes has proven an effective strategy for improving quality of care in nursing homes.
- Although improvement comes slowly, it can be meaningful and fostered on much larger scales through collaborative and campaigns. These approaches can provide the focus and energy to improve both bedside processes and system level changes despite the increasingly difficult environment nursing homes operate.
- Facilities participating voluntarily in the community-wide quality initiative, Advancing Excellence in America’s Nursing Homes, improved at a greater rate in clinical areas than non-participants.
- Maintaining (let along improving) care in nursing homes has proven difficult due to the constantly increasing acuity of new residents entering facilities.