Over the past few years, nursing homes have been the target of much public scrutiny. Within the past five years, several major reforms have been put in place to improve the lives of nursing home residents. These reforms have gradually improved quality of care, while addressing some underlying issues, such as increasing resident-employee turnover rates and staffing shortages.
However, despite the tremendous improvement in quality care in nursing homes across the US, residents and their families still face numerous challenges in gaining the most appropriate care for their loved ones.
One major challenge is overuse of long-term care services. Nursing homes are known to overuse cognitive and behavioral services, which can be highly beneficial for many residents but which leave them feeling underutilized. When nursing homes have too many residents with cognitive impairment, residents are a high-risk population, and overuse of services can lead to confusion and frustration for all parties. Not only that, but overuse of cognitive and behavioral services often results in greater turnover rates for residents. The higher turnover rates, which in turn leave the residents feeling overused, further increase the difficulty nursing homes have in implementing quality care systems and maintaining staff in the facility.
As a result, we often don’t know the whole story of why some resident are not receiving the best care. Last week, two of us published a National Center for Health Statistics report, published in the Archives of Internal Medicine, on the leading causes of death in nursing homes. The Centers for Medicare and Medicaid Services (CMS) provided $500,000 for our research. In addition to publishing the results of the study, the team also published some tools that were developed as part of the study, as well as other information regarding which nursing homes may be harming or serving their residents.
The report identified more than 300 serious and longer-term safety violations in nursing homes across the US in 2016. In addition, more than 1.5 million Medicare patients were enrolled in a nursing home last year that had 10 or more residents who had lived there less than one year.
Additionally, the data included very few outcomes data: mortality, interventions, and intensive care unit admissions rates.
In order to better understand who is harmed and why, we compiled the information from nursing home discharge records, information found in CMS citation reports, and state survey reports, along with other data available in CMS’s website.
Our report revealed that problems were most common when nursing homes are unable to manage an intensive care unit resident, who could contribute to a nursing home’s occupancy rate. For example, while fewer residents than in the past have attended long-term care hospitals, there has been an increase in the number of long-term care hospital stays for nursing home residents, and the number of deaths. Among the group we examined, the more intensive the care the resident received in the nursing home, the more often they would die in the long-term care hospital. Furthermore, our analysis revealed that non-complaints more often identified nursing home residents with long-term care hospitalization problems.
To address these issues, we suggest CMS draft new standards for the use of intensive care services and non-complaints. As we publish the data on harmful outcomes in nursing homes, providers and patients will have access to the details that could help improve care.
Meanwhile, following the success of the report, we have partnered with the pharmaceutical industry to develop a Data Acquisition Gateway to support the development of more sophisticated health and health data. We plan to offer the gateway to hospital systems and nursing homes to improve care and to better understand the quality of care provided.
There is still a lot of work to be done to help nursing homes live up to their title as health care professionals, to understand which residents are being harmed, and to address these problems. We plan to continue working with CMS and industry to make this access to data more accessible and useful to both providers and their patients. Together, we hope to have a real impact in reforming nursing homes so that all residents receive the best care possible.