The Changing Definitions of Nursing Homes - Research Paper Example

Healthcare trend: Nursing homes Healthcare trend: Nursing homes The changing definitions of nursing homes have made it difficult to define it. Over the past years, the term has undergone various modifications. The only consistent definition of nursing homes has arisen in response to regulations and health policies. However there are yet small differences in these definitions in different states. The most-accepted definition of nursing homes has been put across by the National Center for Health Statistics (NCHS). According to the NCHS, a nursing home is “a facility with three or more beds that is either licensed as a nursing home by its state, certified as a nursing facility under Medicare or Medicaid, identified as a nursing unit in a retirement center, or determined to provide nursing or medical care” (Giacalone, 2001). There are other terminologies that are employed to define the nursing home industry such as extended care family, intermediate care family etc. Various policies have been passed in relation to the nursing home industry. This is mainly because healthcare costs and related debates are a major area of concern for regulatory bodies as health takes up a major proportion of the budget in developed countries all over the world. The nursing home industry falls under the jurisdiction of both the federal and state governments. According to Giacalone (2001), each state has the authority to license nursing homes. Moreover the states are allowed to set their own conditions for licensing requirements, reimbursement policies, regulations, classification systems, and terminologies, although the essence of the structure remains the same. The state departments also have an impact on the health policies that are present about nursing homes as they are allowed to enact their own set of requirements if the nursing homes have adult day care facilities and AL units (Giacalone, 2001). Nursing homes are characteristic of covering for the costs of acute care rehabilitation in an economical way. They allow the patients to recover post-operatively in an environment that not only caters to their healthcare needs as dispensed by their health condition but also usually provides them a sanctuary to recover outside the typical hospital environment (Day, 2010). Nursing homes also care for people who have end-of-life or chronic needs. The fraction of people who are discharged from the nursing home amounts to about one-third. Private institutions for long-term care were set up for the first time in 1935 as the Old Age Assistance program, which was a public aid for the aged with low salaries (Andersen, Rice & Kominski, 2007). Despite being an aid for the public, the program particularly stopped residents of public facilities from accessing the services. The program was purposed to shut down low-standard almshouses for the destitute and the sick and to shift the care of the aged to private institutions or facilities, with the costs being covered by state and federal government. It was in 1950s that the federal government took the initiative to set up nursing homes. The reason for such a step was to come up with a solution to the shortage of empty beds in hospitals and to allow patients who required less intensive care to be moved to facilities that catered to their health needs. Moving hospital patients to less intensive care also had the benefit of reducing healthcare costs (Andersen, Rice & Kominski, 2007). When the Medicare and Medicaid were introduced in 1965, the public expenditure on nursing homes increased significantly, leading to rapid proliferation of the number of nursing homes. The nursing home was presented as a medical facility, with Medicare and Medicaid putting greater focus on the nursing aspect of the facility rather than the medical. Diagnosis-Related Groups (DRGs) also contributed to the growth and popularity of nursing homes. DRGs, started in 1984, allowed prospective payment for hospital care, and permitted hospitals to reduce their costs by discharging patients to nursing homes and cut down the healthcare costs by making the hospital stay shorter. As a consequence, many nursing homes started promoting the medical aspect of the healthcare that they provided in order to attract Medicare funding for patients that have been discharged (Andersen, Rice & Kominski, 2007). The Balanced Budget Act of 1997 was witness to the “most significant and sweeping changes” and maximum cut-downs in Medicaid funding since 1981 (Sultz & Young, 2008). The Act removed the minimum payment standards, meeting which were a prerequisite for states in establishing reimbursement rates for nursing homes, hospitals etc. However Medicaid still continued to fund more than 50% of all nursing home care, making it the largest insurer of the nursing home industry. The Legislation called for a repeal of the Boren Amendment which required that the states give some “reasonable and adequate” payment for the services that they were receiving under Medicaid (Schnedier, 1997). The Balanced Budget Act allowed the states to draft a "public process for determination of rates of payment for covered nursing home care”, resulting in the publication of the recommended and the final rates in combination with their basic methods and supporting arguments (Schnedier, 1997). Other regulations that have been passed regarding nursing homes have been related to the regulation of the standards of the facilities. It was in the early 1970s that lack of quality in nursing home care entered the political scene. This resulted in the passage of the many regulations over the period of time (Mason, Leavitt & Chaffee, 2007). The federal Omnibus Budget Reconciliation Act (OBRA) of 1987 was one such legislation that extensively covered the lack of standard healthcare protocol present in some nursing facilities. The Act reported greatly on the extensive use of chemical and physical restraints, lack of sufficient and effective supervision and care by healthcare professionals like nurses and doctors, as well as the falling quality of life that was characteristic of many nursing homes. The state of nursing home care even in the late 1980s was far from optimal and a matter of concern for both the providers of the care and the clients. Jost (1989) noted that these problems were largely attributable to the fact that most of the nursing home care was under private institutions and the payment rates were not sufficient to sustain quality healthcare. The 1987 Nursing Home Reform Act tried to counter these problems by setting standards for operative problems that arose regularly, devising survey methods to monitor process, outcome and structure and putting into effect flexible sanctions to deal with the plethora of issues that occurred in inadequate nursing homes (Jost, 1989). Since the late 1980s, there has been considerable improvement in the quality of care that is being delivered in nursing homes. However recent research in nursing homes suggests many more improvements that can be put into action by the administration to curb urinary incontinence, malnutrition, pressure sores and pain (Andersen, Rice & Kominski, 2007). Moreover researchers have noted that not-for-profit nursing homes provide better care than their for-profit counterparts. The stakeholders are concerned that most of the research on the quality of healthcare provided by nursing homes has been directed towards medical outcomes, with little emphasis on improving the quality of life at the facility from the viewpoint of the clients. Despite the improvements that have been taking place, Mason, Leavitt & Chaffee (2007) state that the healthcare provided by nursing homes is still of poor quality and there is weak regulatory enforcement. The OBRA 1987 had pushed up the hopes of the people, and it was anticipated that the Act would contribute greatly to the improvement of the survey and enforcement system and in the process, improve the quality; however, these expectations are yet to be met (Mason, Leavitt & Chaffee, 2007). In a report published in 2003, 90% of the nursing homes had a huge aggregate of 105, 000 deficiencies for not meeting the federal standards. This accounted for an assortment of regulations that culminated in “unnecessary resident weight loss, pressure ulcers, accidents, infections, decline in physical functioning and many other problems” (Mason, Leavitt & Chaffee, 2007). Moreover the US Senate Committees held several hearings from 1998 to 2003 on the basis of studies conducted on nursing homes by the Government Accountability Office, consistently pushing the Centers for Medicare and Medicaid (CMS) to vouch for and take concrete steps for the improvement of the survey an enforcement process (Mason, Leavitt & Chaffee, 2007). It is unethical to not provide quality healthcare and to violate the standards set by the federal governments. Moreover it is wastage of the resources and funding by the government if the resources are not being utilized efficiently and good medical outcomes are not being achieved. Since 2000, the nursing industry has been one of the most highly regulated industries in the country. However looking at the problem from the dimension of regulatory control is not consistent with a holistic solution to the problem. Regulation can go only as far as the provision of a quality floor. In the past, the few facilities that did meet the minimum standards for regulation were popular amongst clients. Furthermore, the industry had no competition; therefore it lacked the necessary drive that competition provides to improve and monitor the quality of the facilities. There was an automatic demand for nursing home care by Medicaid patients, and this discouraged any further competition. Market segmentation approaches also enabled the facilities to stay out of direct contact with competition from other industries (Giacalone, 2001). Therefore one way of improving the quality of nursing homes would be to increase the competition. Empirical evidence substantiates the argument that market competition does influence the quality of nursing home care and “greater market concentration is linked to improved quality of nursing home care” (Santerre & Neun, 2009). Gilderbloom (2008) is of the view that by increasing the number of nursing home beds in order to provide a healthy vacancy rate, there would be increased competition amongst the suppliers of nursing home care and the quality of nursing homes would subsequently be ameliorated. The Dutch government has also passed healthcare reforms that have strategized on increasing competition and thus increasing quality and efficiency of the healthcare system (Rapoport, Jacobs & Jonsson, 2009). The disadvantage of increasing competition would be the increased costs of funding such a reform. However the advantages clearly outweigh the disadvantage due to the long-term gains that the healthcare industry would achieve with improvement in quality. Thus, increasing competition can be a good option to improve quality of nursing home care. Reference List Andersen, R., Rice, T. H., & Kominski, G. F. (2007). Changing the U.S. health care system: key issues in health services policy and management (3rd ed). John Wiley and Sons. Day, T. (2010). About Nursing Homes. Retrieved from http://www.longtermcarelink.net/eldercare/nursing_home.htm Giacalone, J. A. (2001). US nursing home industry. M.E. Sharpe. Gilderbloom, J. I. (2008). Invisible city: poverty, housing, and new urbanism. University of Texas Press. Jost, T. S. (1989). Regulation of the quality of nursing home care in the United States. International Journal of Quality Health Care, 1(4), 223-228. Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2007). Policy & politics in nursing and health care (5th ed.). Elsevier Health Sciences. Rapoport, J., Jacobs, P., & Jonsson, E. (2009). Cost Containment and Efficiency in National Health Systems: A Global Comparison. Wiley-VCH. Santerre, R. E., & Neun, S. P. (2009). Health Economics (5th ed.). Cengage Learning. Schnedier, A. (1997). Overview of Medicaid Provisions in the Balanced Budget Act of 1997, P.L. 105-33. Retrieved from http://www.cbpp.org/cms/index.cfm?fa=view&id=2138 Sultz, H. A., & Young, K. M. (2008). Health Care USA: Understanding Its Organization and Delivery (6th ed.). Jones & Bartlett Learning. Read More