Nursing Home Quality - Essay Example

Annotated Bibliography: WEBSITES http www.medicare.gov/default.asp This site tells us about how can a nursing home qualify to serve Medicaid and Medicare beneficiaries. This site has ample information on all aspects of Medicaid connected with nursing home care 2. http://www.cms.hhs.gov/NursingHomeQualityInits/ We have already heard about Quality Initiative, this site explains what that initiative is all about and claims to "provide[s] consumer and provider information on the quality of care in nursing homes" 3. http://www.consumerreports.org/cro/health-fitness/nursing-home-guide/nursing-home-quality-monitor/0608_nursing-home-quality-monitor.htm This site contains information about nursing homes so one can make more informed decisions. Information is based on customer reviews and objective third party investigation. 4.http://www.nccnhr.org/ This site is the official website of National Citizen's coalition for nursing reforms. The site explains what are the problems with nursing home care and shows how nccnhr is helping to reform nursing home care. The site claims that, "NCCNHR provides information and leadership on federal and state regulatory and legislative policy development and models and strategies to improve care and life for residents of nursing homes and other long term care facilities." 5. http://aspe.hhs.gov/daltcp/reports/statenh.htm This website contains a study on quality improvement programs in nursing homes in various states. The site claims that the purpose of this "study is to inform state and federal policymakers about state-initiated quality improvement programs, with the particular goal of providing information to states that may wish to develop similar programs in their state." 6. http://providers.ipro.org/index/index An independent site that provides information on various medical facilities including nursing homes. The site contains information on quality efforts by IPRO in the state of New York alone. The site claims that "IPRO has entered into the 8th Scope of Work (SOW) as the Medicare Quality Improvement Organization (QIO) for New York State. IPRO's Nursing Home Quality Improvement (NHQI) team works with nursing homes throughout the state to help improve the quality of care for nursing home residents by providing facilities with complimentary clinical resources, quality improvement materials, and, where indicated or requested, 1:1 technical support." 7.http://www.aarp.org/research/longtermcare/nursinghomes/aresearch-import-686-FS83.html This site provides legal information concerning nursing homes in the US. The site deals particularly with the NURSING HOME REFORM ACT OF 1987 and any information pertaining to that can be accessed on this site. 8. http://www.amda.com/consumers/initiative.cfm A website for information concerning various terminologies and data used in studies on nursing home care. The site is useful in explaining where the data comes and how it is analyzed. 9. http://www.memberofthefamily.net/reports.htm A good website that contains information on different nursing homes in various states. The site rates nursing home care on key quality indicators based on recent survey results. 10. http://www.elder-abuse-foundation.com/html/assessments.html It is an excellent site containing important information on elderly abuse in nursing homes. This site helps consumers identify signs of elderly abuse and directs them to seek legal help in their states. Articles The Extent of Quality Improvement Activities in Nursing Homes -- Lee and Wendling 19 (6): 255 -- American Journal of Medical Quality This article addresses the problem of quality of nursing home care, which it recognizes as a cause of concern. The article discusses in detail the Nursing Home Quality Initiative launched by the federal government, which is meant to improve quality (QI). In order to assess the effectiveness of this initiative, the article examines the preparation done for the implementation of QI. The data comes from surveys of two Kansas nursing homes and it is found that most answers are socially acceptable in nature unless they are framed properly. Which means that people may not always tell the truth about quality care unless questions are framed in such a way that they can elicit correct and accurate responses. Sustaining effective QI programs is a problem due to ineffective leadership. The Relationship Between Quality of Care and Costs in Nursing Homes -- Weech-Maldonado et al. 21 (1): 40 -- American Journal of Medical Quality This article studies the effects of quality of care on costs in nursing homes. More than 700 nursing homes in 5 states were studied in 1996 and costs are defined as costs incurred on total patient care. Mood changes and worsening of ulcers were taken as quality indicators. The authors found that as quality increased, costs decreased and observed this through an inverted U-shaped curve. Stakeholders' Opinions Regarding Important Measures of Nursing Home Quality for Consumers -- Harrington et al. 14 (3): 124 -- American Journal of Medical Quality This article is very important as it studies the "specific categories and indicators of quality used by the Health Care Financing Administration in the survey and certification process for nursing homes in the US". Selected sample of "administrators, directors of nursing, state survey agency training coordinators, state ombudsmen, and nursing home advocates" were used and it was conducted in 1996. The three important categories of quality were identified as "quality of care, quality of life, and residents' rights". The three important quality-of-care survey items were identified as "general quality of care, maintenance of activities of daily living, and appropriate treatment for impairment in activities of daily living". Three important quality-of-life items were determined as "dignity, self-determination and participation, and accommodation of resident needs". Resident rights items were taken as "to be able to exercise general rights, to be informed of one's condition, and to be free of reprisal when making complaints". It was found that greater quality assurance was required and should be focused on these important items identified by the stakeholders in nursing homes Quality Assessment in Nursing Home Facilities: Measuring Customer Satisfaction -- Mostyn et al. 15 (2): 54 -- American Journal of Medical Quality This article actually summarizes a national study that assessed the "reliability and validity of a nursing home customer satisfaction survey". The survey was conducted on 159 facilities where 200 questionnaires were distributed to residents. Response rate was 53 percent and satisfaction was measured on "Comfort and Cleanliness, Nursing, Food Services, and Facility Care and Services". Satisfaction ratings differed among facilities. Does an Increase in the Medicaid Reimbursement Rate Improve Nursing Home Quality -- Grabowski 56 (2): 84 -- Journals of Gerontology Series B: Psychological Sciences and Social Sciences This article studies the history of reimbursements and their impact on nursing home quality. The authors feel that previous researches have mostly focused on the impact on "Medicaid reimbursement policy in improving quality in the presence of certificate-of-need (CON) and construction moratoria regulation". This particular article on the other hand studies the extent to which Medicaid reimbursement may affect a nursing home's decision to improve quality under CON and moratoria. The study found that increase in Medicaid reimbursement was seen as a positive influence on quality by the professional staff however the nonprofessional staff did not find any significant differences. However the study did not find any support for the assumption that Medicaid reimbursement negatively affects quality of nursing homes. The article however supports the idea that CON laws are losing their importance. Distribution of African Americans in Residential Care/Assisted Living and Nursing Homes: More Evidence of Racial Disparity -- Howard et al. 92 (8): 1272 -- American Journal of Public Health This articles studies the racial difference found in nursing home quality. Using a sample of 181 residential care/assisted living (RC/AL) facilities and 39 nursing homes in 4 states, the study found that racial disparities were found in long-term care facilities. Most African Americans were confined to predominantly black nursing homes, which were located in rural areas and were less clean. White had better nursing homes with proper lighting and better services. These racial differences were attributed to economic disparities that exist in the localities where nursing homes were located and of the people who were admitted in them. Whether these differences affect care couldn't be determined. Facility Effects on Racial Differences in Nursing Home Quality of Care -- Fennell et al. 15 (4): 174 -- American Journal of Medical Quality This article was mainly concerned with the review of literature available on the subject of "racial/ethnic differences in nursing home quality, segregated access to nursing home care, and organizational and community factors that may influence access and quality of care". The study collates data on nursing homes in various counties in four states. Medicaid payment and risk-adjusted nursing home quality measures. Grabowski DC, Angelelli JJ, Mor V. Health Affairs, 23, no. 5 (2004): 243-252 This article measures the impact of Medicaid payments on quality of care in nursing homes. The article recognizes Medicaid as "the dominant payer of U.S. nursing home services" but maintains that there is no clear connection between "Medicaid payment rates and quality." this lack of clarity in association is attributed to the lack of "resident-level, risk-adjusted information on quality". This article thus examines the connection of Medicaid with risk-adjusted quality indicators. Higher payment was found to have a positive impact on "incidence of pressure ulcers and physical restraints but not daily pain". It was also concluded that quality of nursing homes would be affected negatively if "budget shortfalls force state legislatures to freeze or reduce Medicaid rates." Quality Report Cards and Nursing Home Quality. Dana B. Mukamel, PhD1, and William D. Spector, PhD2, The Gerontologist 43:58-66 (2003) This article assesses the impact of "publicly disseminated quality report cards" on quality of care in nursing homes. Vast literature is reviewed and experience is also utilized for collection of data on "report cards for hospitals, physicians, and health plans" and this is applied particular to nursing home care. The article finds that such quality reports have a bearing on "informing consumers' choices and providing incentives for quality improvement". But this impact may not always be large. The study concludes that, "quality report cards should be viewed as one of several options to ensure higher quality nursing home care". Nursing Home Closures and Quality of Care Nicholas G. Castle. Medical Care Research and Review, Vol. 62, No. 1, 111-132 (2005) This article studies an interesting association between low quality nursing homes and their closure. The study is based on the hypothesis that "lower-quality facilities will be more likely to close than higher-quality facilities". Using some important quality indicators such as "physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychotropic medication use", the article studies some "approximately 12,000 facilities from 1992 to 1998" and finds that its hypothesis is supported by the data collated. It was also found that nursing home closure is an exception and chances of that every happening is low even if quality is poor. DISCUSSION The literature studied for this paper discusses quality of nursing homes from various aspects including quality initiative and is impact, racial differences, Medicaid payments, possible closure and quality reports. The literature reveals that quality of nursing home care has been a cause of concern for a long time and various measures have been taken to improve quality. The most widely discussed is federal government's Quality Initiative, which aims at improving the quality of care in nursing homes. It was found that Medicaid payments are the dominant source of funding and in the absence of these payments; quality in nursing homes may slide even further. There was no specific connection found between Medicaid reimbursements and quality of care but it was found that higher reimbursements had a positive impact on quality using the indicator of pressure ulcers. Discussion of closure revealed that low quality nursing homes do not often result in the closure of these facilities. In another study it was found that quality report cards were a good measure for improvement of quality. It was interestingly revealed that data collected through surveys is not often accurate because people may not respond correctly to questions unless surveys were properly structured. Racial differences were also found in nursing homes since most African American facilities were located in rural areas. These disparities were attributed to economic differences but quality of care due to racial differences couldn't be determined. However it was concluded that, "A growing African American elderly population could accentuate existing racial disparities in long-term care. Therefore, it is critical to improve our understanding of the extent, causes, and implications of uneven racial distribution across the spectrum of long-term care." The structure of nursing home units have also been studied and it was found that while "nursing home is a type of total institution", yet literature doesn't reveal consistent findings on structure of nursing home and quality of care. The information available on various websites listed above is useful considering its on issues which are not discussed in the literature such as laws, comparison of nursing homes in various states and the programs initiated by states and their impact. This information especially the data available on the quality of care in nursing home is important since it helps consumers make informed decisions. The website also provides generalized but useful information about terminologies such as risk-adjustment and risk measurement. This information is essential for understanding the conclusions drawn by studies found in articles. Discussion on questions: The interview questions were properly structured and drew important information from one consumer about quality of nursing home care. This information is useful since it comes from first hand knowledge of a person who has had experience of nursing homes. The interviewee's husband was admitted to a nursing home and she explains why she found the experience highly unpleasant. What we learn from her experience is that nursing homes are not as much about facilities available as about the personnel employed. The attention, care and compassion shown by the staff is the most critical factor in making nursing home experience worthy. We learn that consumers are wary of nursing homes and will not opt for one unless their patients are totally bed ridden. In many cases, people might actually prefer to take care of the elderly at home. The nursing home atmosphere may actually aggravate an elderly person's condition. Staff is either short or not compassionate enough. They are not well versed in the skill of communicating with older people. The nursing staff and its behavior is what determine the quality of nursing home care. The interviewee repeatedly made it clear that she preferred a nursing home where staff was courteous and caring and where it worked with family members and really listened to them. This kind of first hand information is not found in literature and is highly useful in determining the real indicators of quality of care. Read More