Researcher: 'Nursing home policies that affect quality have achieved their intended effect.'

WASHINGTON, Sept. 28 /PRNewswire-USNewswire/ -- Today the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care (Alliance) publicly released the nursing, post-acute, short term and rehabilitative sector's first comprehensive report examining quality trends in the nation's nursing homes. The report highlights the positive evolution of skilled nursing and rehabilitation facilities along with the subsequent benefit to cost-effective seniors' care; consumer and workforce satisfaction; and other key, quantifiable measures of quality, including public policy recommendations for moving quality forward.

AHCA and the Alliance stated that this is the first independent report that sets a framework for evaluating quality and provides recommendations for policy changes that will make quality metrics more reliable. AHCA and Alliance leaders also stated that improvements in quality, as highlighted in the report, could not be achieved without a stable economic environment, an important relationship essential to maintaining these positive trends. The organizations urged Congress to recognize the quality improvements that have been achieved in recent years and to understand the crucial role stable Medicare financing plays in ensuring continued enhancements to quality of care and quality of life for millions of seniors being cared for in America's nursing and rehabilitation facilities.

In releasing the report, Bruce Yarwood, President and CEO of AHCA and Alan Rosenbloom, President of the Alliance, noted that in 2002, the organizations joined forces to make a national, public pledge to improve quality care for long term care patients and residents. This initiative, known as Quality First, also promised to promote a progressive workplace for long term care employees, to advance the development of key quality measures, and to publicly and transparently report the results of quality performance. The long term care leaders commented, "Prior to Congress' current call for increased transparency, AHCA and the Alliance took the lead in engaging experts in quality and nursing and rehabilitation facility care to critically assess data and trends to provide an unbiased, objective view of what has happened with quality in nursing homes since we began the Quality First initiative in 2002."

The report relies primarily on independent findings from some of the nation's leading researchers and research organizations in long term and post-acute care, such as Avalere Health; Vincent Mor, Ph.D., Professor and Chair of the Department of Community Health at the Brown University School of Medicine and former Director of the Brown University Center for Gerontology and Health Care Research; Steven Littlehale, Senior Researcher of PointRight; My InnerView results; and analyses of publicly available government data.

Some of the key findings from the independent assessments included the following:

• There appears to be a relationship between adequate reimbursement and quality improvements, access to quality care.
• Nursing and rehabilitation facilities have evolved to meet the special demands and needs of an aging population. There is a much greater focus on post-acute care, and the length of stay of most patients is now less than 90 days.
• Quality has improved in many areas, though work remains. Measurable improvements can be seen in the decline in use of physical restraint, decline in amount of pressure ulcers, improvements in key clinical areas such as weight loss, dehydration and levels of patient activity and pain management.
• Existing metrics don't reflect the different patient populations in nursing and rehabilitation facilities currently or the increasing specialization that is resulting from these different patient populations.
• Patient satisfaction levels are high. Eighty-five percent of consumers rated their overall satisfaction and their recommendation for the facility to others as either "excellent" or "good" - up three percent from 2007 to 2008.
  

"Our goal in preparing this report is to provide an objective and representative overview of the state of nursing and rehabilitative care in America by highlighting key quality trends, improvements, and areas that require more attention in the future," added Yarwood. "Many challenges we face as a sector are directly related to the dramatic transformation that our nation's nursing and rehabilitation facilities have undergone in recent years to meet the changing care needs of the people we serve and the modernization of long term care delivery. At the same time, we acknowledge there is still much room for improvement, and these areas are detailed in the report so that providers, consumers, and policymakers can work together to chart a course for continuing improvement now and into the future."

Said Rosenbloom, "In reviewing the report findings, there is ample evidence that initiatives such as Quality First have improved quality of care and quality of life for our residents and patients in several key clinical areas. Evidence is mounting on the cost effectiveness of our services as compared with other sites of service - especially for patients requiring intensive rehabilitative and medically complex care. Because facilities devote a full 70 percent of operating expenses to wages, benefits and other labor costs, Medicare funding stability from Washington is essential to the ongoing, successful operation of our quality improvement programs."

Other data in the report show increases in patient, family and caregiver satisfaction. Conversely, residents, their families, and staff also identify areas that merit improvement - such as the need for greater choice, better communication from management, and more relief from substantial job stress in the workplace.

The Quality Report also adds detailed context to the ongoing debate surrounding the transformation of the nation's long term care system - and the fact that the common perception of a "nursing home" is outdated. In reality, the report details, the nursing home of the 21st century is more accurately described as a "nursing and rehabilitation facility" where nearly half of the people admitted are able to return home after a stay of approximately just one month.

Issuance of this Quality Report is a clear indicator of AHCA's and the Alliance's current and future intent to advance quality. The long term care organization leaders agree, "Through an annual Quality Report, we will consistently communicate our sustained efforts to improve quality. We remain committed to continuously promoting quality improvements, challenging ourselves to always do better and building upon these gains in the years ahead."

The 2009 Annual Quality Report is available in its totality at www.ahca.org and www.aqnhc.org.

Key Quotes from 2009 Annual Quality Report:

". . ..rising Medicaid payment rates appear to be associated with great improvements in quality and lower rates of hospitalizations." (Changes in the Quality of Nursing Home Care in the U.S., Vincent Mor, Ph.D. and PointRight Inc.)

"Almost 40 percent of short-stay Medicare patients were discharged to the community in 2006 after a stay of about 25 days, highlighting the interdependence of facility and home-based care." (Nursing and Rehabilitation Facilities of the 21st Century, Avalere Health, LLC)

Quality trends derived from government data sources between 1999 and 2007 show measurable improvements in key clinical areas such as weight loss, dehydration, level of patient activity and pain management, among others. (Quality: By the numbers; Quality Trends from Publicly Available Data)

"Working in concert with all stakeholders at both the national and state level we can, together, assist nursing homes to become high performance organizations that, in partnership with their staff and residents, will be able to demonstrate the long term care community's ability to deliver the best." (Mary Jane Koren, M.D., M.P.H., Chair, National Steering Committee for Advancing Excellence)

"Nursing home policies that affect quality have achieved their intended effect, although not as completely as many would desire." (Changes in the Quality of Nursing Home Care in the U.S., Vincent Mor, Ph.D. and PointRight Inc.)

"Regulator's inspection results don't seem to resolve the confusion amongst the other measures and indeed, appear to be responsive to political influences at both the state and national levels." (Changes in the Quality of Nursing Home Care in the U.S., Vincent Mor, Ph.D. and PointRight Inc.)

"It is clear that nursing home quality is multi-dimensional; what is also becoming clear is that it is no more appropriate to compare all nursing homes with one another than it would be appropriate to compare an Obstetrics hospital with an Oncology hospital." (Changes in the Quality of Nursing Home Care in the U.S., Vincent Mor, Ph.D. and PointRight Inc.)

"Eighty-five percent of consumers rated their overall satisfaction and their recommendation of the (nursing) facility to others as either 'excellent' or 'good' - up 3 percent from the previous year (2007 - 2008)." (2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes, My InnerView)

SOURCE American Health Care Association