The National Academies Press

Currently Skimming:

Index
Pages 407-416

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.

From page 407... ... See also Medicaid, discrimination Automatic cancellation clause, 151, 157- 158 B Barthel Index, 57 Bed supply control of, 5, 17, 18 policy, 23, 43-44, 190, 199 Beds demand, 10, 23, 196- 197 Medicare and Medicaid, 9 notification of lapse of hold period, 28 occupancy rates, 199 per 1,000 population, 199, 361 per licensed nurse, 102, 362 totals during 1978-1983 by state, 360 Bedsores, see Decubitus ulcers Beverly Enterprises, 187 Board and care homes, 8 Board of Internal Medicine, 4 C Care conferences, notification, 30 Case mix referencing in survey protocols, 110, 115-118, 191 reimbursement systems, 66, 92 staffing according to, 102 stratification, 131 use for measuring outcomes, 63-64 Certificates of need, 189 Certif ication Distinct party 94 expenditures, 169 federal-state role relationships, 38, 104 of geriatric competence, 4 requirements, 32 state resources committed to, 315 temporary, 156 Certification regulations conceptual basis, 71 costs of revision, 247 dissatisfaction with, 70 distinction between SNFs and ICFs, 69 HCFA requirement to modify, 15 post-1974 efforts to revise, 245 proposed, 247 proposed changes in, 25-32, 206-207 407 Read the entire page →
From page 408... ... , 29-31, 81, 88-89 dental services, 280 dietetic services, 83, 275-276 disaster preparedness, 29, 290 federal, state, and local regulatory compliance, 254-255 governing body and management, 29, 3' 95, 255-269 improvements needed in, 22, 77-98 infection control, 289-290 laboratory and radiological services, 29, 279-280 medical direction, 29, 269-270 medical records, 29, 282-284 nurse's aide training, 29, 81 nursing services, 79-80, 83, 271-275 patient activities, 282-284 pharmaceutical services, 278-279 physical environment, 285-289 physical services, 270-271 proposed, 80-81 resident assessment, 25-26 residents' rights, 27-29, 81 skilled nursing facility, 26-27, 77-80 social services, 32, 83, 99, 281-282 specialized rehabilitation services, 276-278 transfer agreement, 29, 284-285 utilization review, 29, 290-297 vagueness-in, 79-80 Congregate care, 8 Consultants to nursing homes, 150 Consultation, guidelines needed on, 154 Consumer advocates concerns, 7 effectiveness of, 41 lack of, 5 role, 19-20, 173- 183 Consumer protection, 173, 178 Contractures, 84, 118, 119, 121 Correction plans content, 152 duration and number, 154 evaluation of, 150 federal criteria for, 152 guidelines needed on, 154 noncompliance with, 152 revision of, 154- 155 . state review procedures for, 152 verification, 321-322 Council of State Governments, 240 D Data collection improvements needed in, 22 instruments, 56 on surveys, 37 Day-care centers, 8 Decertification appeals of, 159- 160 grounds for, 149, 156- 157 invocation, 13, 104 need for, 154 of SNFs, 78 voluntary, 157 Decubitus ulcers, 62, 80, 84, 116-119, 121, 379 Dehydration, 84, 118, 119, 121, 380 Demographic trends, 10, 17, 196- 197 Department of Health, Education, and Welfare, lawsuit against, 16 Depression, 49 Deregulation of nursing homes, 4 Directors of nursing, nursing home duties of, 101-102 Domiciliary care, 8 Elderly, cause of functional impairments in, 52 Employment estimates for nursing and personal care facilities, 10 Enforcement attitudes and, 13, 147- 149 data availability, 170 federal funding of, 169- 170 formal, initiation of, 153 goal of, 148 inadequacies, 146- 147 laxity, 7 legal staff for, 322 policies, improvements needed in, 22, 147-149 of residents' rights, 85 state variations in, 40, 241, 321-325 written guidelines for, 323 Enforcement procedures detailed, 154 federal, 150- 161 state, 162- 169 Expenditures, nursing home care, 10 Extended care facilities (ECFs) Read the entire page →
From page 409... ... Long-term care demonstration projects, 200 financing, 199 types, 8 Long-Term Care Ombudsman Program, 20 Long-term-care services alternatives tot 197 available in 1985, 8 Read the entire page →
From page 410... ... . po 1cles suspension for new admissions, 13, 158-161 Medicaid Provider Agreement, 30 Medicaid reimbursement policies, 17, 18, 22-23, 43, 193- 196 rates, 6, 17, 57, 72, 76, 92-93, 198 Medicaid statutes amendment, 39-40 duty imposed on Secretary of HHS by, 16 Medical Assistance for the Aged, 239 Medical care indicators, 380 Medical records access, 28-29, 173- 174 Medicare advent of, 241-245 beds, number of, 9 budgets for certification, 133 certification, federal funding for, 133 eligibility, 75 participation in 1966- 1967, 148 payments, facilities not receiving, 9 Medicare and Medicaid acts, passage of, 240 Medications, as key indicators of resident care, 378-379 Mental depression, 116 Mental Status Questionnaire, 59 Mini-Mental State Examination, 59 Monitoring nursing home performance, 12, 32-38, 75, 104-145 outcomes, 64 state activities, 105 Montana resident classification scheme, 64 N National Center for Health Statistics surveys, 19, 192 National Citizens' Coalition for Nursing Home Reform study on care quality, 51-52 National Committee on Vital and Health Statistics, 192 National Health Corporation, 65, 187 National League for Nursing, 187 National Summary of State Nursing Home Ombudsmen Reports for the United States, 92 New York State Department of Health, case-mix reimbursement system, 65-66 Noncompliance extended survey for, 122 history of, 156 Notification of resident transfer or discharge, 28-29, 81, 95-96 Nurses number of licensed, 362 nursing home duties of, 73 ratio of RNs to LPNs in 1981, 362 shortage of, 74 training in gerontology, 101, 186-187 wages, 1 0 1 See also Charge nurses; Licensed practical nurses; Registered nurses Nurse's aides importance, 52 problems, 11, 101 training, 29, 30, 73, 81, 89-91, 366 turnover rate, 11, 73, 90, 101 wages, 101 Nursing care indicators, 380 hours per resident-day, state minimum, 365 labor assessment, 65 time requirements, 65, 200 Nursing home care alternatives to, 23, 199-200 conflicts of values and ethics in, 52-53 cost assessments, 65-66 expenditures, 10 goals, 48 high-quality, requirements for providing, 48-49 inadequacies in, 21 need for, 197 payment for, 17 Nursing home compliance determinations, 107 with federal standards, 14 Nursing home costs for resident assessment system, 212 reduction measures, 10, 194 Nursing home industry Read the entire page →
From page 411... ... multiple occupancy, 44 social services, 31 staff turnover, 112, 173 staff-to-resident ratios, 54 staffing, 10, 32, 44, 49-50, 72-74, 80, 98-103, 173, 190, 200-201 standard for certification of, 147-148 standards, state variations in, 241 state differences in licensing criteria, . 72 state inspection of, 1 substandard, 148 survey agency consultation with, 150 temperatures, 97-98 time devoted to survey process, 80 transfer opportunities, 6 use of resident assessment data, 75 in violation of Medicaid standards, 243 withholding federal funds from, 242 See also Extended care facilities; Intermediate care facilities o Office of Long-Term Care, 246 Office of Nursing Home Affairs, 14, 244, 245 Old Age Assistance, 238, 239 Older Americans Act, 20, 41, 44, 97, 175-176, 180, 206 OMB Circular A-122, effect on ombudsman program, 42, 180- 181 Ombudsman programs Read the entire page →
From page 412... ... 412/ INDEX AoA commitment to, 179 constraints, 180 funding of, 179 legal support for, 180 national extent of, 177- 178 national leadership for, 42, 179 responsibilities, 176- 177, 180 state survey agency relationships with, 108, 182-183 statutory authority for, 175- 176, 179 strengthening of, 41-42, 179 written agreements with, 42 Ombudsmen access to residents, 31, 96-97, 180 complaint handling by, 177 definition, 177 lobbying by, 180 role, 177, 178 Quality assurance components, 12, 60-61, 69-71 interpreting and using information for, 61 -68 programs, nursing home chains, 187 Quality of care effects of Medicaid reimbursement policies on, 23 factors affecting, 17-21, 41-42, 45-50, 60-61, 171-189 incentives to ensure, 188 indicators, see Key indicators of resident care instruments for assessing, 56-60 measurement of, 61-62, 64, 83 process for ensuring, 10 standards of reference, 62-63 Quality of life Omnibus Budget Reconciliation Act, 138, 158 condition of participation, 27, 79, 81-83 Organic brain syndrome, 59 effects of Medicaid reimbursement Outcomes case mix in measuring, 63 components, 5S-56, 74 measurement of care quality, 64, 74-75, 83-84, 118-120 negative, 84, 114, 121, 122 positive, 84, 114 Overmedication, 84, 116 p Paperwork reduction, 89 Patient Appraisal and Care Evaluation, 246 Patient Assessment Computerized system, 65 Patient Care and Services (PaCS) , 130-132 Patient care management system, 16 Patient Care Profile, 65 Patient Classification for Long-Term Care, 56, 249 Patient classification system, information needs of, 56 Personal care indicators, 380 Philadelphia Geriatric Center Mental Status Questionnaire, 59 Physical environment in nursing homes, 31-32, 81, 97-98 Physical restraints, 84, 116, 118, 121 Populations 85 and older, 10 elderly, by state, 369 over age 75, 10 Private-pay rates, 94 Prognostic adjustment factor, 64 Provider agreement termination, 156- 157 concerns, 7 Psychotropic drugs, 54, 118 Q Quality assessment criteria outcome component, 55-56 process component, 54-55 structural component, 53-54 policies on, 23 factors affecting, 41-42, 51-53, 171-189, 382 process for ensuring, 10 R Receivership, 166- 168 Recertification, 147, 149, 155- 156 Recommendations amendment of Medicaid statutes, 39-40, 155, 168, 205 amendment of Social Security Act Title XIX, 36, 135 changes in federal certification criteria, 25-32, 74, 77, 80, 81, 85-89, 91, 95-98, 204 complaint handling, 34, 125 consolidated "Administrations condition, 29-31, 88-89, 204 cost implications of, 210-212 data collection and analyses, 37, 137 elimination of distinctions between SNFs and ICFs, 25, 74, 204 elimination of institutional reports, 30, 89, 204 enforcement, 38, 168, 170, 205-206 environmental standards, 31-32, 98-100 extended survey for sample of facilities, 36, 128 federal funding, 36, 135 federal oversight of survey operations, 37, 38, 139-140 federal-state certification role relationships, 38, 145 incentives, 35, 127 integration of inspection of care, 38, 142 Medicaid discrimination, 30, 95, 204 Medicare/Medicaid survey and certification requirements, 32, 111 notification, 30, 96, 204 nurse's aide training, 30, 91 Read the entire page →
From page 413... ... INDEX/413 nursing home inspection and cost reports, 41, 174 nursing home staffing, 32, 100 ombudsmen, 31, 41 -42, 97, 181 - 183 quality assessment in survey process, 34, 124, 205 quality of life as a condition of participation, 27, 81, 204 resident assessment, 25-26, 77, 204 resident interviews, 35, 124 resident participation in facility decision-making, 31, 96, 204 resident-centered, outcome-oriented approach to regulation, 27, 85, 204 residents' rights as condition of participation, 27-29, 86-88, 204 resurvey, 34, 123, 155 rewriting of SNF conditions and standards, 26, 80, 204 room occupancy, 44, 202 social services, 31-32, 97-99, 204 strengthening state regulation, 36, 135 survey development, 35-36, 120, 205 survey instruments and protocols, 33, 115, 128 survey team staffing, 37, 136 survey timing, 32-33, 113 surveyor qualifications, 37, 136 surveyor training, 36, 37, 129, 137 withholding Medicaid matching funds fron states, 37, 38, 140 Registered nurses in nursing homes, 101- 103 minimum number in nursing homes, 73 Regulation, see Federal regulation of nursing homes, history of; Nursing home regulation Regulations, 6, 7 combining SNF and ICE requirements, 15 HCFA-proposed, 15 proposed, 16 state, steps to strengthen, 36 state, use of resident assessment data, 75 See also Certification regulations Regulatory changes opposition to, 2 proposed, 1, 2, 16 Regulatory costs of recommendations, 211-212 Regulatory policies affecting quality of care, 17-19 Regulatory quality assurance goals, 67-68 Regulatory standards, violations of, 15 Regulatory system components for quality assurance, 12 goals, 12 improvements needed in, 22-23 Rehabilitation exercises, 52 services, intensive short-term, 9 Rehabilitation Act, 1974 amendments to section 504, 93 Rehabilitative care indicators, 380 Resident assessment audit, 113-114, 191 data computerization, 77, 187, 191-192 data system, 25-26, 43, 48, 49, 61-67, 73-77, 84, 102, 119, 128, 132, 135, 191-193, 207-211 data uses, 75, 115, 119, 191 instrument development, 76, 79, 117 scores, 115-116 system, cost to nursing home, 212 Resident care management system, proposed, 15 needs, 46-47 planning, 49-51, 75 Resident mix in SNFs and ICFs, 10 optimization, 17 Resident participation in advisory and family councils, 29, 87 in care planning, 51 forms of, 31 in management decision-making, 19-20, 29, 31, 81, 96, 172-173 in social, religious, and political activities, 29, 51, 88 Resident-staff relationships, 11, 52, 173 Residents 75 and older, 10, 46, 73 85 or older, 10, 196-197 ability of to choose among nursing homes, 5 abuse, 3, 121, 173 accidents, notification of, 30 bed-bound, 80, 116, 117 characteristics, 46 charge assessment, 65 classification instruments, 57-58 clinically depressed, 121 dependencies of in activities of daily living, 372 differences in social circumstances, 46 disabilities, 5 discharge, 28 financial status, 6 functional status, 48-49 heavy care, 9, 73, 91 -93, 103, 196, 198, 199, 212 interviews with, 35, 121, 123- 124 lack of information on, 18 lack of privacy, 51 length of stay, 46-47 Medicaid/Medicare, 17 mental status, 49, 116-117, 118, 121, 381, 384 needs, insensitivity to, 107- 108 neglect of, 3, 121, 173 non-English speaking, 28 ombudsman access to, 31, 96-97 outcomes, factors influencing, 55 physical inactivity of, 84 physically dependent, 117, 119, 121 Read the entire page →
From page 414... ... 414/ INDEX physically independent, 118 population, heterogeneous, 8 private-pay, 5, 17 projected number in 1980-2040, 371 receiving public assistance, 239 relocation of from substandard facilities, 322 satisfaction assessment of, 60 social activities, 51 spending down by, 5, 19, 93-94 stratification, 116 transfer of, 28, 167 treatment plan, 48 under age 65, 8 weight loss in, 119, 120 Residents' rights language arrangements for non-English speakers, 28, 86 legal, 28, 86 medical and social records, 28, 87 notification of transfer, discharge, lapse of bed-hold periods, 28-29, 86 sanctions for violations of, 165 standard, elevation to a condition, 15, 27, 81, 85-88 violations of, 7 written facility policies, 28, 87 written statement of, 28 Resource Utilization Groups classification system, 57, 66 S Sanctions against chronic or repeat violators, 39-40 appeals of, 159 application of, 148 factors influencing use, 162, 323-324 favorably rated, 164, 325 federal, 13, 154, 156 imposition of, 151 initiation of, 154 intermediate, 39, 159, 162- 169 number applied in 1983, 162, 323-324 number available by state, 322 obstacles to successful use, 164 procedures for implementing, 165 repeat deficiencies, 155 residents' rights violations, 165 state, 162-168 state availability and use, 13, 315 state variation in, 321 statutory availability and use, 315 types, 155-161, 163, 165-168 use of prior survey findings in applying, 160 withholding certificates of need, 189 Senile dementia, 49, 58 Skilled nursing facilities (SNFs) accreditation of, 1 certification regulations, 14 conditions of participation, 26, 77-98, 254-297 Recertification of, 78 development of regulations for, 244 federal standards for, 14 implementation of regulations for, 242 Medicaid reimbursement rates for, 72 Medicaid reimbursement rates per resident-day, 367 number and percentage by state, 72, 357 number failing to meet conditions of participation, 149 providing ICE services, standards for, 314 regulatory requirements, 9, 69-74 resident-days of care reimbursed, 368 staffing, 72 use of ECF standards for, 242 Social isolation, 84, 85 Social Security Act amendment of Title XIX, 36, 135, 204-206 1950 amendments, 238 1956 amendments, 239 section 1864, 143- 144 standard-setting amendment, 240 Title XIX, 133 Social services, nursing home, 31, 81, 99-100 Social workers required for nursing facilities, 32 Standard survey basis of, 114-115, 123 deficiencies found in, 154 process, scope of, 33-34 protocol, 131 resident categories, 120 scope of, 118, 121 shorter, 110 validity of, 128 See also Surveys Standardized instruments for resident assessment, 64, 74 Standards ambiguity of, 7 improvements needed in, 22 inadequacies in, 7, 70 licensure, state variations in, 13, 72-73 state regulatory, 319-320 See also Intermediate Care Facility standards; Process standards State licensure and certification agencies, survey of, 315-350 State regulatory capability, increasing, 132-140 State survey agencies activities, expenditures for, 133-135, 373-374 budgets, state variations in, 318-319 consultation, 150 enforcement procedures and guidelines of, 153 funding and staffing variations, 109, 375 HCFA expenditures for, 133-135 performance evaluation, 138 Read the entire page →
From page 415... ... forms, 70, 130- 131 instruments, 33, 116, 123, 127- 128, 209-210 intensity of, 107 of nursing homes and residents, 19 of state licensure and certification agencies, 315-350 outcome-oriented, 119 policies, current, 148 predictability of, 106- 107, 110 purpose, 116 questionnaire, 327-350 requirements, 32 results, consistency of, 129 scoring procedures, 109, 122 timing and frequency of, 32-33, 106-107, 111 - 113 validation, 138 visits, 1980 total, 376 See also Extended survey; Standard 112, 149, 150-154 survey U U.S. Senate Special Committee on Aging, 14, 91, 240 Urinary incontinence, 84, 116, 379 Utilization review, 141 - 142 Violations authority to punish, 148 ma jor, 161 regulatory standards, 15 repeat, 160-161 residents' rights, 7 W Well-being objective, 53 subjective, 54, 59 Read the entire page →

From page 407...

... See also Medicaid, discrimination Automatic cancellation clause, 151, 157- 158 B Barthel Index, 57 Bed supply control of, 5, 17, 18 policy, 23, 43-44, 190, 199 Beds demand, 10, 23, 196- 197 Medicare and Medicaid, 9 notification of lapse of hold period, 28 occupancy rates, 199 per 1,000 population, 199, 361 per licensed nurse, 102, 362 totals during 1978-1983 by state, 360 Bedsores, see Decubitus ulcers Beverly Enterprises, 187 Board and care homes, 8 Board of Internal Medicine, 4 C Care conferences, notification, 30 Case mix referencing in survey protocols, 110, 115-118, 191 reimbursement systems, 66, 92 staffing according to, 102 stratification, 131 use for measuring outcomes, 63-64 Certificates of need, 189 Certif ication Distinct party 94 expenditures, 169 federal-state role relationships, 38, 104 of geriatric competence, 4 requirements, 32 state resources committed to, 315 temporary, 156 Certification regulations conceptual basis, 71 costs of revision, 247 dissatisfaction with, 70 distinction between SNFs and ICFs, 69 HCFA requirement to modify, 15 post-1974 efforts to revise, 245 proposed, 247 proposed changes in, 25-32, 206-207 407

Read the entire page →

From page 408...

... , 29-31, 81, 88-89 dental services, 280 dietetic services, 83, 275-276 disaster preparedness, 29, 290 federal, state, and local regulatory compliance, 254-255 governing body and management, 29, 3' 95, 255-269 improvements needed in, 22, 77-98 infection control, 289-290 laboratory and radiological services, 29, 279-280 medical direction, 29, 269-270 medical records, 29, 282-284 nurse's aide training, 29, 81 nursing services, 79-80, 83, 271-275 patient activities, 282-284 pharmaceutical services, 278-279 physical environment, 285-289 physical services, 270-271 proposed, 80-81 resident assessment, 25-26 residents' rights, 27-29, 81 skilled nursing facility, 26-27, 77-80 social services, 32, 83, 99, 281-282 specialized rehabilitation services, 276-278 transfer agreement, 29, 284-285 utilization review, 29, 290-297 vagueness-in, 79-80 Congregate care, 8 Consultants to nursing homes, 150 Consultation, guidelines needed on, 154 Consumer advocates concerns, 7 effectiveness of, 41 lack of, 5 role, 19-20, 173- 183 Consumer protection, 173, 178 Contractures, 84, 118, 119, 121 Correction plans content, 152 duration and number, 154 evaluation of, 150 federal criteria for, 152 guidelines needed on, 154 noncompliance with, 152 revision of, 154- 155 . state review procedures for, 152 verification, 321-322 Council of State Governments, 240 D Data collection improvements needed in, 22 instruments, 56 on surveys, 37 Day-care centers, 8 Decertification appeals of, 159- 160 grounds for, 149, 156- 157 invocation, 13, 104 need for, 154 of SNFs, 78 voluntary, 157 Decubitus ulcers, 62, 80, 84, 116-119, 121, 379 Dehydration, 84, 118, 119, 121, 380 Demographic trends, 10, 17, 196- 197 Department of Health, Education, and Welfare, lawsuit against, 16 Depression, 49 Deregulation of nursing homes, 4 Directors of nursing, nursing home duties of, 101-102 Domiciliary care, 8 Elderly, cause of functional impairments in, 52 Employment estimates for nursing and personal care facilities, 10 Enforcement attitudes and, 13, 147- 149 data availability, 170 federal funding of, 169- 170 formal, initiation of, 153 goal of, 148 inadequacies, 146- 147 laxity, 7 legal staff for, 322 policies, improvements needed in, 22, 147-149 of residents' rights, 85 state variations in, 40, 241, 321-325 written guidelines for, 323 Enforcement procedures detailed, 154 federal, 150- 161 state, 162- 169 Expenditures, nursing home care, 10 Extended care facilities (ECFs)

Read the entire page →

From page 409...

... Long-term care demonstration projects, 200 financing, 199 types, 8 Long-Term Care Ombudsman Program, 20 Long-term-care services alternatives tot 197 available in 1985, 8

Read the entire page →

From page 410...

... . po 1cles suspension for new admissions, 13, 158-161 Medicaid Provider Agreement, 30 Medicaid reimbursement policies, 17, 18, 22-23, 43, 193- 196 rates, 6, 17, 57, 72, 76, 92-93, 198 Medicaid statutes amendment, 39-40 duty imposed on Secretary of HHS by, 16 Medical Assistance for the Aged, 239 Medical care indicators, 380 Medical records access, 28-29, 173- 174 Medicare advent of, 241-245 beds, number of, 9 budgets for certification, 133 certification, federal funding for, 133 eligibility, 75 participation in 1966- 1967, 148 payments, facilities not receiving, 9 Medicare and Medicaid acts, passage of, 240 Medications, as key indicators of resident care, 378-379 Mental depression, 116 Mental Status Questionnaire, 59 Mini-Mental State Examination, 59 Monitoring nursing home performance, 12, 32-38, 75, 104-145 outcomes, 64 state activities, 105 Montana resident classification scheme, 64 N National Center for Health Statistics surveys, 19, 192 National Citizens' Coalition for Nursing Home Reform study on care quality, 51-52 National Committee on Vital and Health Statistics, 192 National Health Corporation, 65, 187 National League for Nursing, 187 National Summary of State Nursing Home Ombudsmen Reports for the United States, 92 New York State Department of Health, case-mix reimbursement system, 65-66 Noncompliance extended survey for, 122 history of, 156 Notification of resident transfer or discharge, 28-29, 81, 95-96 Nurses number of licensed, 362 nursing home duties of, 73 ratio of RNs to LPNs in 1981, 362 shortage of, 74 training in gerontology, 101, 186-187 wages, 1 0 1 See also Charge nurses; Licensed practical nurses; Registered nurses Nurse's aides importance, 52 problems, 11, 101 training, 29, 30, 73, 81, 89-91, 366 turnover rate, 11, 73, 90, 101 wages, 101 Nursing care indicators, 380 hours per resident-day, state minimum, 365 labor assessment, 65 time requirements, 65, 200 Nursing home care alternatives to, 23, 199-200 conflicts of values and ethics in, 52-53 cost assessments, 65-66 expenditures, 10 goals, 48 high-quality, requirements for providing, 48-49 inadequacies in, 21 need for, 197 payment for, 17 Nursing home compliance determinations, 107 with federal standards, 14 Nursing home costs for resident assessment system, 212 reduction measures, 10, 194 Nursing home industry

Read the entire page →

From page 411...

... multiple occupancy, 44 social services, 31 staff turnover, 112, 173 staff-to-resident ratios, 54 staffing, 10, 32, 44, 49-50, 72-74, 80, 98-103, 173, 190, 200-201 standard for certification of, 147-148 standards, state variations in, 241 state differences in licensing criteria, . 72 state inspection of, 1 substandard, 148 survey agency consultation with, 150 temperatures, 97-98 time devoted to survey process, 80 transfer opportunities, 6 use of resident assessment data, 75 in violation of Medicaid standards, 243 withholding federal funds from, 242 See also Extended care facilities; Intermediate care facilities o Office of Long-Term Care, 246 Office of Nursing Home Affairs, 14, 244, 245 Old Age Assistance, 238, 239 Older Americans Act, 20, 41, 44, 97, 175-176, 180, 206 OMB Circular A-122, effect on ombudsman program, 42, 180- 181 Ombudsman programs

Read the entire page →

From page 412...

... 412/ INDEX AoA commitment to, 179 constraints, 180 funding of, 179 legal support for, 180 national extent of, 177- 178 national leadership for, 42, 179 responsibilities, 176- 177, 180 state survey agency relationships with, 108, 182-183 statutory authority for, 175- 176, 179 strengthening of, 41-42, 179 written agreements with, 42 Ombudsmen access to residents, 31, 96-97, 180 complaint handling by, 177 definition, 177 lobbying by, 180 role, 177, 178 Quality assurance components, 12, 60-61, 69-71 interpreting and using information for, 61 -68 programs, nursing home chains, 187 Quality of care effects of Medicaid reimbursement policies on, 23 factors affecting, 17-21, 41-42, 45-50, 60-61, 171-189 incentives to ensure, 188 indicators, see Key indicators of resident care instruments for assessing, 56-60 measurement of, 61-62, 64, 83 process for ensuring, 10 standards of reference, 62-63 Quality of life Omnibus Budget Reconciliation Act, 138, 158 condition of participation, 27, 79, 81-83 Organic brain syndrome, 59 effects of Medicaid reimbursement Outcomes case mix in measuring, 63 components, 5S-56, 74 measurement of care quality, 64, 74-75, 83-84, 118-120 negative, 84, 114, 121, 122 positive, 84, 114 Overmedication, 84, 116 p Paperwork reduction, 89 Patient Appraisal and Care Evaluation, 246 Patient Assessment Computerized system, 65 Patient Care and Services (PaCS) , 130-132 Patient care management system, 16 Patient Care Profile, 65 Patient Classification for Long-Term Care, 56, 249 Patient classification system, information needs of, 56 Personal care indicators, 380 Philadelphia Geriatric Center Mental Status Questionnaire, 59 Physical environment in nursing homes, 31-32, 81, 97-98 Physical restraints, 84, 116, 118, 121 Populations 85 and older, 10 elderly, by state, 369 over age 75, 10 Private-pay rates, 94 Prognostic adjustment factor, 64 Provider agreement termination, 156- 157 concerns, 7 Psychotropic drugs, 54, 118 Q Quality assessment criteria outcome component, 55-56 process component, 54-55 structural component, 53-54 policies on, 23 factors affecting, 41-42, 51-53, 171-189, 382 process for ensuring, 10 R Receivership, 166- 168 Recertification, 147, 149, 155- 156 Recommendations amendment of Medicaid statutes, 39-40, 155, 168, 205 amendment of Social Security Act Title XIX, 36, 135 changes in federal certification criteria, 25-32, 74, 77, 80, 81, 85-89, 91, 95-98, 204 complaint handling, 34, 125 consolidated "Administrations condition, 29-31, 88-89, 204 cost implications of, 210-212 data collection and analyses, 37, 137 elimination of distinctions between SNFs and ICFs, 25, 74, 204 elimination of institutional reports, 30, 89, 204 enforcement, 38, 168, 170, 205-206 environmental standards, 31-32, 98-100 extended survey for sample of facilities, 36, 128 federal funding, 36, 135 federal oversight of survey operations, 37, 38, 139-140 federal-state certification role relationships, 38, 145 incentives, 35, 127 integration of inspection of care, 38, 142 Medicaid discrimination, 30, 95, 204 Medicare/Medicaid survey and certification requirements, 32, 111 notification, 30, 96, 204 nurse's aide training, 30, 91

Read the entire page →

From page 413...

... INDEX/413 nursing home inspection and cost reports, 41, 174 nursing home staffing, 32, 100 ombudsmen, 31, 41 -42, 97, 181 - 183 quality assessment in survey process, 34, 124, 205 quality of life as a condition of participation, 27, 81, 204 resident assessment, 25-26, 77, 204 resident interviews, 35, 124 resident participation in facility decision-making, 31, 96, 204 resident-centered, outcome-oriented approach to regulation, 27, 85, 204 residents' rights as condition of participation, 27-29, 86-88, 204 resurvey, 34, 123, 155 rewriting of SNF conditions and standards, 26, 80, 204 room occupancy, 44, 202 social services, 31-32, 97-99, 204 strengthening state regulation, 36, 135 survey development, 35-36, 120, 205 survey instruments and protocols, 33, 115, 128 survey team staffing, 37, 136 survey timing, 32-33, 113 surveyor qualifications, 37, 136 surveyor training, 36, 37, 129, 137 withholding Medicaid matching funds fron states, 37, 38, 140 Registered nurses in nursing homes, 101- 103 minimum number in nursing homes, 73 Regulation, see Federal regulation of nursing homes, history of; Nursing home regulation Regulations, 6, 7 combining SNF and ICE requirements, 15 HCFA-proposed, 15 proposed, 16 state, steps to strengthen, 36 state, use of resident assessment data, 75 See also Certification regulations Regulatory changes opposition to, 2 proposed, 1, 2, 16 Regulatory costs of recommendations, 211-212 Regulatory policies affecting quality of care, 17-19 Regulatory quality assurance goals, 67-68 Regulatory standards, violations of, 15 Regulatory system components for quality assurance, 12 goals, 12 improvements needed in, 22-23 Rehabilitation exercises, 52 services, intensive short-term, 9 Rehabilitation Act, 1974 amendments to section 504, 93 Rehabilitative care indicators, 380 Resident assessment audit, 113-114, 191 data computerization, 77, 187, 191-192 data system, 25-26, 43, 48, 49, 61-67, 73-77, 84, 102, 119, 128, 132, 135, 191-193, 207-211 data uses, 75, 115, 119, 191 instrument development, 76, 79, 117 scores, 115-116 system, cost to nursing home, 212 Resident care management system, proposed, 15 needs, 46-47 planning, 49-51, 75 Resident mix in SNFs and ICFs, 10 optimization, 17 Resident participation in advisory and family councils, 29, 87 in care planning, 51 forms of, 31 in management decision-making, 19-20, 29, 31, 81, 96, 172-173 in social, religious, and political activities, 29, 51, 88 Resident-staff relationships, 11, 52, 173 Residents 75 and older, 10, 46, 73 85 or older, 10, 196-197 ability of to choose among nursing homes, 5 abuse, 3, 121, 173 accidents, notification of, 30 bed-bound, 80, 116, 117 characteristics, 46 charge assessment, 65 classification instruments, 57-58 clinically depressed, 121 dependencies of in activities of daily living, 372 differences in social circumstances, 46 disabilities, 5 discharge, 28 financial status, 6 functional status, 48-49 heavy care, 9, 73, 91 -93, 103, 196, 198, 199, 212 interviews with, 35, 121, 123- 124 lack of information on, 18 lack of privacy, 51 length of stay, 46-47 Medicaid/Medicare, 17 mental status, 49, 116-117, 118, 121, 381, 384 needs, insensitivity to, 107- 108 neglect of, 3, 121, 173 non-English speaking, 28 ombudsman access to, 31, 96-97 outcomes, factors influencing, 55 physical inactivity of, 84 physically dependent, 117, 119, 121

Read the entire page →

From page 414...

... 414/ INDEX physically independent, 118 population, heterogeneous, 8 private-pay, 5, 17 projected number in 1980-2040, 371 receiving public assistance, 239 relocation of from substandard facilities, 322 satisfaction assessment of, 60 social activities, 51 spending down by, 5, 19, 93-94 stratification, 116 transfer of, 28, 167 treatment plan, 48 under age 65, 8 weight loss in, 119, 120 Residents' rights language arrangements for non-English speakers, 28, 86 legal, 28, 86 medical and social records, 28, 87 notification of transfer, discharge, lapse of bed-hold periods, 28-29, 86 sanctions for violations of, 165 standard, elevation to a condition, 15, 27, 81, 85-88 violations of, 7 written facility policies, 28, 87 written statement of, 28 Resource Utilization Groups classification system, 57, 66 S Sanctions against chronic or repeat violators, 39-40 appeals of, 159 application of, 148 factors influencing use, 162, 323-324 favorably rated, 164, 325 federal, 13, 154, 156 imposition of, 151 initiation of, 154 intermediate, 39, 159, 162- 169 number applied in 1983, 162, 323-324 number available by state, 322 obstacles to successful use, 164 procedures for implementing, 165 repeat deficiencies, 155 residents' rights violations, 165 state, 162-168 state availability and use, 13, 315 state variation in, 321 statutory availability and use, 315 types, 155-161, 163, 165-168 use of prior survey findings in applying, 160 withholding certificates of need, 189 Senile dementia, 49, 58 Skilled nursing facilities (SNFs) accreditation of, 1 certification regulations, 14 conditions of participation, 26, 77-98, 254-297 Recertification of, 78 development of regulations for, 244 federal standards for, 14 implementation of regulations for, 242 Medicaid reimbursement rates for, 72 Medicaid reimbursement rates per resident-day, 367 number and percentage by state, 72, 357 number failing to meet conditions of participation, 149 providing ICE services, standards for, 314 regulatory requirements, 9, 69-74 resident-days of care reimbursed, 368 staffing, 72 use of ECF standards for, 242 Social isolation, 84, 85 Social Security Act amendment of Title XIX, 36, 135, 204-206 1950 amendments, 238 1956 amendments, 239 section 1864, 143- 144 standard-setting amendment, 240 Title XIX, 133 Social services, nursing home, 31, 81, 99-100 Social workers required for nursing facilities, 32 Standard survey basis of, 114-115, 123 deficiencies found in, 154 process, scope of, 33-34 protocol, 131 resident categories, 120 scope of, 118, 121 shorter, 110 validity of, 128 See also Surveys Standardized instruments for resident assessment, 64, 74 Standards ambiguity of, 7 improvements needed in, 22 inadequacies in, 7, 70 licensure, state variations in, 13, 72-73 state regulatory, 319-320 See also Intermediate Care Facility standards; Process standards State licensure and certification agencies, survey of, 315-350 State regulatory capability, increasing, 132-140 State survey agencies activities, expenditures for, 133-135, 373-374 budgets, state variations in, 318-319 consultation, 150 enforcement procedures and guidelines of, 153 funding and staffing variations, 109, 375 HCFA expenditures for, 133-135 performance evaluation, 138

Read the entire page →

From page 415...

... forms, 70, 130- 131 instruments, 33, 116, 123, 127- 128, 209-210 intensity of, 107 of nursing homes and residents, 19 of state licensure and certification agencies, 315-350 outcome-oriented, 119 policies, current, 148 predictability of, 106- 107, 110 purpose, 116 questionnaire, 327-350 requirements, 32 results, consistency of, 129 scoring procedures, 109, 122 timing and frequency of, 32-33, 106-107, 111 - 113 validation, 138 visits, 1980 total, 376 See also Extended survey; Standard 112, 149, 150-154 survey U U.S. Senate Special Committee on Aging, 14, 91, 240 Urinary incontinence, 84, 116, 379 Utilization review, 141 - 142 Violations authority to punish, 148 ma jor, 161 regulatory standards, 15 repeat, 160-161 residents' rights, 7 W Well-being objective, 53 subjective, 54, 59

Read the entire page →

← Previous Chapter Skim

This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.

Index Pages 407-416

Index
Pages 407-416