Improving the Quality of Care in Nursing Homes (1986) / Chapter Skim
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7. Issues Requiring Further Study
7. Issues Requiring Further Study
Pages 190-202
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From page 190... ...
policies governing the methods and amounts of payments to nursing homes for care of residents eligible for support under the Medicaid program; (3) policies affecting the supply of nursing home beds in the context of the growing demand for all types of long-term-care services; (4)
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From page 191... ...
It involves, among other things, determining the standard data to be collected and designing and testing techniques for collecting it reliably, developing instruction manuals, and training thousands of people to conduct the assessment routinely and with reasonable integrity and reliability. It also involves developing case-mix groupings based on definitions related primarily to assessment scores, and developing auditing procedures and the standards to be used by state auditors to determine whether the error rates they find are acceptable.
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From page 192... ...
Responsibility for conducting the study should be assigned to a group of technically competent and broadly knowledgeable people who are sensitive to the concerns and needs of all interested parties -- the residents, the nursing home operators, state governments, and the federal government. Such a study will have implications for the future role and contents of the National Nursing Home Survey conducted by the National Center for Health Statistics.
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From page 193... ...
Recommendation 7-1: The Secretary of HAS should order a study to design a system for acquiring and using resident assessment data to meet the legitimate and continuing needs of state and federal government agencies. The Secretary also should order a study to determine the needs for other data about nursing homes that would facilitate regulation and policy development.
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From page 194... ...
Nursing homes can control costs by controlling admissions (choosing a mix of residents whose needs for care can be paid for by the revenues they bring in) , and by controlling such variable operating expenses as staffing, food, laundry, housekeeping, and plant maintenance.
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From page 195... ...
Some rates or payment levels may be insufficient to provide desirable quality of care and quality of life, but the distribution of the payment into cost line items within a facility may have a greater impact on quality than the amount of the total payment. Furthermore, such aspects of facility performance as the quality, motivation, and efficiency of the care-giving staff, and managerial skill, are not price-sensitive.
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From page 196... ...
For the over-85 group, the projected increase is 108 percent during this period, from 2.6 to 5.4 million.7 The rapid growth of the population aged 85 and over is likely to have a significant impact on the size and structure of the nursing home population.8 If current age and sex-specific institutionalization rates hold, the proportion of the residents in nursing homes who are age 85 and over can be expected to rise from 31 percent in 1980 to 43 percent in 2000. This increase in the mean age of the nursing home population implies a greater proportion of heavy-care residents.
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From page 197... ...
will so improve that nursing home care requirements will decrease, or that other long-termcare services could be substituted for nursing home care for the majority of individuals now found in nursing homes. The population in nursing homes is likely to be more aged and more disabled, and some form of mental disability (particularly Alzheimer's disease)
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From page 198... ...
The hospitals could not find nursing homes willing to admit them, so they were allowed to remain in more costly hospital beds pending availability of nursing home beds. The study found that the backup population consisted of two groups of patients: one group spent a short time in the queue before being admitted to nursing homes; the second group spent a long time in the queue.
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From page 199... ...
But bed occupancy rates -- and excess demand -- appear to exist in most states.6 The uncharted policy areas that are related to bed supply are (1) alternative ways of financing long-term care -- particularly the possibility of private insurance arrangements for financing long-term-care services that are not primarily health-related and are not limited to payment for services provided in nursing homes; and (2)
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From page 200... ...
The HCFA has sponsored some innovative long-term-care demonstration projects during the past 10 years. More recently, under statutory authority contained in the 1981 budget legislation, states have been granted waivers to permit them to use Medicaid funds to finance services in community-based, long-term projects designed to prevent unnecessary institutionalization for individuals who otherwise could receive Medicaid support only in nursing homes.9 Systematic evaluation of these programs has just begun.
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From page 201... ...
The question is: Should the HCFA require that all new construction, or additions to existing nursing homes, be required to have a specified fraction of private rooms? If so, what should that fraction be?
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From page 202... ...
The committee believes that the HCFA should commission a study of this issue to determine the proper balance between single- and multiple-occupancy rooms that should be required in newly constructed nursing homes and in additions to -- or major remodelings of -- existing homes. Recommendation 7-2: The NCFA should commission a study of the costs anc!
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