What is nursing home quality and how it is measured? Gerontologist, 50(4), 426-442. Doi: 10.1093/geron/gng052
Quality of Care for Nursing Homes and Home Health Care Quality of Care for Nursing Homes and Home Health Care 1. What are the major strengths and weaknesses of the nursing home survey process in assuring that residents have high levels of quality of care and quality of life? 2. What do you consider to be the key areas for developing quality metrics in home and community based care? Which ones are easier to measure than others? TEXT BOOK FOR THIS CLASS: McSweeney-Feld, M.H., & Oetjen, R. (2012). Dimensions of long term care management: An introduction. Chicago: American College of Health Executives. SAMPLE ANSWERS (DO NOT COPY) 1. What are the major strengths and weaknesses of the nursing home survey process in assuring that residents have high levels of quality of care and quality of life? The Five –Star quality rating system used by the CMS to review nursing homes and skilled nursing facilities has three main sources of information it uses to determine its rating. First, the use of health inspections is used and should be considered a strength of the program (CMS, 2014). These onsite inspections allow reviewers to determine if a site is meeting Medicare’s minimum standards for quality. Next, another strength of the CMS rating system is the use of staff rating information in its overall quality score (CMS, 2014). This helps ensure that facilities are providing an adequate level of skilled providers to meet the health needs of its patient population which helps increase the overall quality of care. Poorly staffed facilities will not be able to meet all of the health and medical demands of the patients and may result in poorer patient health outcomes and poorer quality of life. Finally, the CMS system looks at 9 different physical and clinical measures such as pressure sore prevalence and patient mobility (CMS, 2014). Collecting and rating this information gives the CMS the ability to determine which sites best meet the clinical needs of the patient. Those that better prevent ailments common to nursing facilities show more attention to detail in caring for patients and thus would seem to be a higher quality facility. However, it appears that little is collected in the way of resident satisfaction. What may be one of the most important aspects of nursing home care is the perceived satisfaction coming from residents. Simple surveys asking questions about the facilities ability to meet their needs and provide the services one would expect from a skilled nursing facility may go a long way in providing an overall quality score. While this may be subjective and difficult to completely quantify, poor ratings from actual residents should be considered in any overall quality score regardless of a facilities ability to do well on standardized measures. Centers for Medicare and Medicaid Services (2014, February). Five-Star quality rating system. Retrieved from http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html 2. What do you consider to be the key areas for developing quality metrics in home and community based care? Which ones are easier to measure than others? One of the most important areas for developing quality metrics would be in clinical outcomes. These should be easily measured as they would be information documented in a patients medical record and can be stored by diagnosis in a facility database. For instance, pressure sore prevalence can be quantified and reported to agencies and would give an indication of the overall quality of care provided. Another key area for quality metric reporting would be in process quality indicators. These metrics would include information in medication administration and can be easily interpreted. However, these “process measures are often criticized as representing measures of documentation rather than actual care” (Castle & Ferguson, 2010). Errors in documentation, while an issue that surely needs to be addressed, may not completely be an indicator of an error in the process that is used to ensure patient care quality. Finally, a structural metric of quality is important as that can provide information on staffing levels including the number of licensed providers available to provide clinical care. Deficiencies in staffing can lead to poor health outcomes and poorer quality of life in nursing home care. These should be easily measured and documented for reporting purposes. However, according to Castle and Ferguson (2010), “it would seem almost intuitive that providing higher levels of caregivers would improve quality of care. However, the literature in this area is somewhat ambiguous-with may empirical studies finding no such relationship.” Castle, N.G., and Ferguson, J.C. (2012). What is nursing home quality and how it is measured? Gerontologist, 50(4), 426-442. Doi: 10.1093/geron/gng052
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