Bush Administration To Expand Nursing Home Quality Initiative After Report Shows Modest Improvements
Bush administration officials on Wednesday announced plans to expand a program launched in 2002 to improve nursing home quality that "has so far had mixed results," the Boston Globe reports. Administration officials said that the expansion will focus on staff turnover, background checks for workers and the "hospital-like environment" in some nursing homes, according to the Globe (Dembner, Boston Globe, 12/23). Every three months, the program provides updated quality scores for the 16,500 U.S. nursing homes in 15 areas.
According to a Globe analysis published earlier this month, under the current program -- which is estimated to cost $120 million over three years -- fewer nursing home residents experience untreated pain or are placed in restraints. However, the program has not led to significant improvements in other areas in nursing home quality, such as the occurrence of pressure sores or the ability of residents to walk, feed themselves or use the bathroom without assistance, the analysis found. As part of the program, the federal government has paid consultants to teach some nursing homes how to reduce pain and pressure sores among residents (California Healthline, 12/13).
On average, the 2,400 nursing homes that agreed to work with the consultants improved their quality more than those that did not work with the consultants, according to report released on Wednesday by the administration. Under the expanded program, the government will pay consultants to build care plans based on "schedules and desires" of nursing home residents and to increase "staff satisfaction and autonomy," the Globe reports. The expanded program will increase focus on the reduction of pressure sores, depression and the use of restraints in nursing homes. However, the expanded program, which is voluntary, will involve only a small number of nursing homes nationwide, according to the Globe (Boston Globe, 12/23).
The administration report, which was based on data that nursing homes must collect from residents as part of their participation in Medicare, also found:
- Nursing homes in 2004 restrained about 7.5% of residents daily, compared with 9.7% in 2002 (Sherman, AP/Las Vegas Sun, 12/22);
- Nursing homes that worked with quality improvement organizations reduced the prevalence of pain in long-term residents by 49% and the use of physican restraints by 33%;
- The rate of nursing home residents with bed sores increased by 0.2 percentage points between 2002 and 2004, although the rate decreased by 0.8 percentage points over the same period among a group of homes that focused on the problem (HHS release, 12/22).
HHS Secretary Tommy Thompson said, "The improved outcomes are a great first step, but we know much more can be done. In fact, we are developing an aggressive nursing home quality plan that will further strengthen our enforcement actions when a nursing home fails to measure up" (AP/Las Vegas Sun, 12/22).
Alice Hedt, executive director of the National Citizens Coalition for Nursing Home Reform, said, "The facilities that have volunteered tend to be the facilities that are eager to improve. We would like to see ... more effort on facilities that are not providing good care."
Barbara Manard, vice president of the American Association of Homes and Service for the Aging, said, "We must be sure we reward quality care to ensure that in the future there will be only two kinds of nursing homes -- the excellent and the nonexistent" (Boston Globe, 12/23).