Poorly Performing Nursing Homes

As more people live longer, the need for quality long-term care for the elderly will increase dramatically. This volume examines the current system of nursing home regulations, and proposes an overhaul to better provide for those confined to such facilities. It determines the need for regulations, and concludes that the present regulatory system is inadequate, stating that what is needed is not more regulation, but better regulation. This long-anticipated study provides a wealth of useful background information, in-depth study, and discussion for nursing home administrators, students, and teachers in the health care field; professionals involved in caring for the elderly; and geriatric specialists.

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.

The Health Care Financing Admin. (HCFA), the federal agency responsible for overseeing the quality of nursing home care, has announced initiatives intended to strengthen enforcement for homes that are found to have repeatedly harmed residents. This report examines whether deficiencies reporting actual harm to residents represent serious problems & the implications of HCFA's proposed action. A random sample of 107 homes' annual & complaint surveys were reviewed that included deficiencies of actual harm to one or more residents. These 107 surveys contained a total of 201 isolated actual harm deficiencies. Charts & tables.

The Centers for Medicare and Medicaid Serv. (CMS) established the Special Focus Facility (SFF) Program to help address poor nursing home performance. States select a subset of homes as SFFs from a list of the 15 poorest performing homes in each state. States survey SFFs twice as frequently as other homes and there are more robust enforcement, including termination, for SFFs that fail to improve within about 18 months. This report: (1) determined the factors states consider in selecting SFFs and how SFFs differed from other nursing homes; (2) evaluated CMS regional office and state adherence to program guidance and the program's impact on homes' performance; and (3) identified other strategies that were used to improve poorly performing homes.

Hospitals and nursing homes are responding to changes in the health care system by modifying staffing levels and the mix of nursing personnel. But do these changes endanger the quality of patient care? Do nursing staff suffer increased rates of injury, illness, or stress because of changing workplace demands? These questions are addressed in Nursing Staff in Hospitals and Nursing Homes, a thorough and authoritative look at today's health care system that also takes a long-term view of staffing needs for nursing as the nation moves into the next century. The committee draws fundamental conclusions about the evolving role of nurses in hospitals and nursing homes and presents recommendations about staffing decisions, nursing training, measurement of quality, reimbursement, and other areas. The volume also discusses work-related injuries, violence toward and abuse of nursing staffs, and stress among nursing personnelâ€"and examines whether these problems are related to staffing levels. Included is a readable overview of the underlying trends in health care that have given rise to urgent questions about nurse staffing: population changes, budget pressures, and the introduction of new technologies. Nursing Staff in Hospitals and Nursing Homes provides a straightforward examination of complex and sensitive issues surround the role and value of nursing on our health care system.

In 1998, the Centers for Medicare and Medicaid Services (CMS) established the Special Focus Facility (SFF) Program to address poor performance by nursing homes. The SFF methodology assigns points to deficiencies cited on standard surveys and complaint investigations, and to revisits conducted to ensure that deficiencies have been corrected. In 2008, CMS introduced a Five-Star Quality Rating System that draws on the SFF methodology to rank homes. This report applied SFF methodology on a nationwide basis. This report determined: (1) the number of most poorly performing homes nationwide; (2) how their performance compared to that of homes identified using the SFF methodology; and (3) the characteristics of such homes.

"[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.