Nursing
Home Quality Measures
The
Center for Medicare and Medicaid Services (CMS) has made public
on the Internet a set of quality measures for nursing homes. These
measures indicate the proportion of residents with a particular
condition in a particular facility. They help nursing homes and
oversight agencies to identify potential problems.
The
data comes from an assessment form, the Minimum Data Set (MDS).
CMS requires nursing homes to complete this form for each resident
at least four times a year and to send the information to state
survey agencies as well as to CMS.
Of
the many conditions tracked by the MDS, information about 10 is
made public. Six relate to long-term chronic care in nursing homes
and four to short-term, sub-acute, post hospital care. All have
been adjusted somewhat to make them as comparable as possible by
taking into account relevant differences in nursing home populations.
A few are also reported with a Facility Admission Profile* adjustment.
The
measures are:
Long
- Term Chronic Care
Percent
of residents who had an unexpected loss of function in some basic
daily activities
Percent
of residents with infections
Percent
of residents with pain
Percent
of residents with pressure sores
Percent
of residents with pressure sores with FAP* adjustment
Percent
of residents in physical restraints
Short
– Term Post-Acute
Percent
of short-stay residents with delirium
Percent
of short-stay residents with delirium with FAP*adjustment
Percent
of short-stay residents with pain
Percent
of short-stay residents who walk as well or better on day 14 as
on day 5 of their stay with FAP* adjustment
How
Quality Measures can Help Consumers
This
new information is not easy to interpret and there are many reasons
to use it cautiously. It adds to, but should not replace, the
traditional ways consumer evaluate and chose nursing homes. Consumers
should visit facilities personally and talk to families in a home
and to knowledgeable, local advocates and professionals.
Quality
measures can be one of the easiest pieces of information to obtain
about nursing homes when a family is deciding where to place a relative.
A home reporting good quality in the various measures is worth
looking into. A home reporting below average quality in some or
all of the measures merits serious questioning about care in those
areas.
For
residents and their families and for family organizations in a nursing
home, the quality measures point to likely areas for improvement
and care areas worth study and monitoring.
CMS
has tied the publication of quality measures to new funding for
improvement efforts available to nursing homes that do poorly on
certain measures; the home care request free help from a local Quality
Improvement Organization. Residents, their families and family
organizations can challenge their homes to seek this help, when
it is needed.
What
Consumers Should Know about the Limitations of Quality Measures
The
measures should be interpreted cautiously for many reasons. The
numbers should serve only a starting point; they indicate where
there is likely to be a problem, but not necessarily where there
is a problem.
The
quality measure gives information, but not the whole picture
For
example, a facility with a higher number of people with pressure
sores may indeed be a problem facility, or it may be a facility
that has a specialty in caring for people who have pressure sores
or admits many new residents with existing pressure sores, perhaps
developed in hospitals. (Some effort has been made to address
this concern by excluding newly admitted residents from the pressure
sores measure and by making the Facility Admission Profile adjustment.)
Further, some pressure sores are unavoidable (for example, in
people in the terminal stages of a disease who have very impaired
immune systems) but most experts think these are very few.
The
way the statistics are complied and the adjustments made are far
from perfect
A
great deal of work over many years has gone into developing these
measures and the various kinds of adjustments used to make the data
comparable and to minimize factors that unfairly make a home’s quality
look worse than it is. Still, most researchers and professionals
feel much more work must be done before quality measures accurately
reflect quality of care.
The
measures all involve quality of care in a nursing home; none measure
quality of life, which, for residents, may be as or more important.
The
numbers are all self reported by nursing homes and not audited
by CMS or the
State.
Websites
Quality
measures can be found on: www.medicare.gov/nhcompare/home.asp
The
site describes each quality measure and the reasons why it was chosen.
Survey
reports are found at addresses:
www.health.state.ny.us/nysdoh/nursing/mframe
www.medicare.gov/nhcompare/home.asp
*The
FAP – “Facility Admission Profile” adjustment – is made to account
for differences in the health conditions of individuals admitted
to nursing homes. For example, a home that admits an unusually
high number of people with pressure sore ulcers will be given
a statistical adjustment lowering its actual pressure sore rate
while a home that admits few people with pressure ulcers will
receive an upward statistical adjustment.
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