The National Imperative to Improve Nursing Home Quality Honoring Our Commitment to Residents, Families, and Staff (2022) / Chapter Skim
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1 Introduction
1 Introduction
Pages 25-46
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From page 25... ...
For others, it serves as their permanent home, a place where they receive care and services that should enable them to live a safe and fulfilled life. Currently, nearly 1.3 million Americans reside in more than 15,000 certified nursing homes (CDC, 2020; KFF, 2020a)
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STUDY CONTEXT Given the vulnerable state of many, if not most, nursing home residents and the large and growing number of older Americans, one would expect that the United States as a nation would ensure that nursing homes provide comprehensive, high-quality, person-centered care for the country's aging parents, aunts and uncles, brothers and sisters, friends, and loved ones. However, the current system of nursing home care in the United States often fails to provide the supports and quality of care necessary to ensure the well-being and safety of nursing home residents -- an unacceptable situation that has long been apparent to those who research, work in, or have loved ones in nursing homes.
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nursing homes received citations for deficiencies in infection control (KFF, 2020c) , and 15 percent received citations for serious deficiencies that resulted in actual harm to a resident or put the resident at immediate risk for harm (KFF, 2020d)
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BOX 1-1 Family Member Perspectives "The pandemic has lifted the veil on what has been an invisible social ill for decades." -- Daughter and caregiver of two parents with dementia who needed nursing home care "I so wish our society valued more highly the lives of those who are elderly and vulnerable and those who serve them. I do not know how to solve that problem." -- M.K.
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. PREVIOUS WORK OF THE NATIONAL ACADEMIES Building upon the 1986 study Improving the Quality of Care in Nursing Homes, the 2001 IOM report Improving the Quality of Long-Term Care provided a comprehensive look at the quality of care and quality of life in long-term care broadly (including nursing homes, home and community-based settings, and residential care facilities)
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on care quality and outcomes, which may include examination of the meaningfulness of the current five-star rating system and how it is interpreted by consumers and clinicians; and/or the validity, efficiency, and effectiveness of the current survey and certifica tion structures and methods, including inspection standards, training of surveyors, and their adherence to standards; • the appropriateness of current emergency preparedness regulations and strategies for nursing homes in light of different environmental and pandemic threats to residents; • the influence of current nursing home real estate ownership and payment models on the delivery of high-quality care and regulatory compliance; • the role of the facility medical director as the clinical leader in nursing homes; • strategies to attract, train, and retain a more skilled workforce to nursing homes and survey agencies; and • the role of nursing homes in the continuum of post-acute and long-term care. The committee will develop a set of findings and recommendations to delin eate a framework and general principles for improving the quality of care in today's nursing homes, delivering high-quality care in a consistent manner, and ensuring the safety and well-being of residents and staff in nursing homes.
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STUDY APPROACH AND SCOPE The Committee on the Quality of Care in Nursing Homes consisted of 17 members with a broad range of expertise, including public health, gerontology/geriatrics, public policy, health care and social care providers, health equity, health information technology, health care financing and administration, nursing home regulation, nursing home quality, emergency preparedness and response, and legal issues. Appendix A provides brief biographies of the committee members and staff.
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Below are some important definitions and distinctions in terminology. Nursing Homes While the terms "nursing home" and "skilled nursing facility" are often used interchangeably, skilled nursing facilities are designed to focus on the provision of short-term medical care after a hospital stay (although they may also provide long-term care for people with chronic illnesses)
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Nursing Home Residents Nursing homes provide care to two different groups of people who have distinct care needs: short-stay individuals who require post-acute care after a hospital stay, and long-stay residents who have a more diverse range of care needs. For the purposes of this report, unless the distinction is important, the committee refers to all individuals within nursing homes as residents, while acknowledging the heterogeneity of the typical population in a nursing home that serves as both a long-term care facility and skilled nursing facility (i.e., long-stay "residents" and short-stay "patients")
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. The committee recognizes person-directed care as an integral element of person-centered care in nursing homes.
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. Settings for long-term care include private homes, independent living facilities, assisted living facilities, nursing homes, and skilled nursing facilities.
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While this was not a study focused on the impact of the COVID-19 pandemic on nursing homes, the committee recognized that the pandemic itself served to reveal and amplify the long-standing challenges and serious problems that exist in nursing home settings and have a direct impact on the quality of care provided. Thus, the COVID-19 pandemic served as another lens through which the committee explored the wide
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Over time, scholars and professional health care organizations have developed a variety of conceptual models in an attempt to concisely define and measure nursing home quality, and, as a framework for this study, the committee created an original conceptual model of the quality of care in nursing homes based on a content analysis of existing conceptual models (or approaches) of health care quality or quality of care in nursing homes (see Box 1-3)
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The conceptual model has three major components -- inputs, nursing home care, and outcomes -- and the model's elements and the evidence supporting them are discussed throughout this report in greater detail. The model presents high-quality nursing home care as having a central focus on the nursing home residents that is person centered, culturally sensitive, respectful, and sensitive to social determinants of health.
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From page 39... ...
therefore, the model positions equity as surrounding nursing home care and envisioned that it must influence each of the categories. Categories of Nursing Home Care In addition to the central focus on residents, four other key categories in the conceptualization of high-quality nursing home care are • Care that is effective, timely, and equitable; • Communication that is caring and responsive to residents, families, providers, and community; • Empowered staff who are knowledgeable, consistent, compassion ate, and team based and who follow through with care; and • An environment that is calm and active (in a way that aligns with residents' needs)
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This ranges from registered nurses involved in planning and care delivery and knowledgeable, interdisciplinary staff who can meet resident basic human and behavioral health needs, to having all staff and leaders working as a team. The category also includes sensitivity to the culture of all staff, residents, and families; respect for residents' needs, likes, and dislikes; collaboration among staff and families in working with residents; and the involvement of staff and families in care plans.
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Chapter 3 examines issues related to quality measurement and quality improvement. Chapter 4 focuses on care delivery in nursing homes, while Chapter 5 examines the workforce that
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. The following chapters present the evidence base for the current quality of care in nursing homes and, ultimately, the committee's integrated set of recommendations to move the nation closer to achieving high-quality, person-centered, and equitable care for all nursing home residents, their families, and the staff who provide care for and support residents' choices and goals.
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2021. High nursing staff turnover in nursing homes offers important quality information.
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1996. Nursing staff in hospitals and nursing homes: Is it adequate?
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2017. Person-directed care planning in nursing homes: Resident, family, and staff perspectives.
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2007. Nursing home care quality: Twenty years after the Omnibus Budget Reconciliation Act of 1987.
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