Health and Disability

On January 31, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) and the Health Care Compliance Association released a report arising from a recent government-industry roundtable called Driving for Quality in Long-Term Care: A Board of Directors Dashboard. The roundtable was held on December 6, 2007 and provided the long-term care industry with an opportunity to inform the OIG of issues surrounding board of directors' oversight of quality of care.

The report includes written summaries of the discussions that took place in breakout groups designed around the following 3 perspectives on the oversight of quality of care: (i) organizational commitment to quality; (ii) processes related to monitoring and improving quality; and (iii) outcome measures related to quality. In the report, a fourth breakout group also considered the benefits of, and challenges to, developing a Quality of Care Dashboard (i.e., a management tool that may provide a way to access and oversee performance on quality of care issues).

RALEIGH, N.C. (AP) -- You can see it at most long-term care centers -- residents in wheelchairs lining hallways, just sitting or rolling slowly down the hall.

But a health service director at a Durham center says it's time to stop parking older people in wheelchairs.

Leslie Jarema of The Forest at Duke says in the old-school nursing homes, people are sitting around the nurses' station and asking for help because they are uncomfortable.

The Midwest-based group called GROW, or Get Residents Out of Wheelchairs, has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners. The group, which has asked Jarema to speak about her approach at The Forest at Duke, also tries to get residents to be as active as possible, encouraging walking to meals, going on foot to the bathroom or shower and taking outside walks with family and friends when possible.

Black nursing home residents are more likely than their white counterparts to be hospitalized for conditions such as dehydration, poor nutrition and bedsores, according to a study to be published in the June issue of the journal Health Services Research, the Washington Post reports. Lead study author Andrea Gruneir and other researchers affiliated with the Brown University Albert Medical School examined data from 2000 on more than 500,000 nursing home residents in 9,000 facilities across the U.S. (Spinner, Washington Post, 1/15).

A very interesting take on LTC and community-based options:

It reminds me way too much, of moving day. That is, moving day to a Long Term Care Facility. The day that our parent or grandparent moves out of their home community and into Long-Term Storage. Dropped off. All looking alike. All gathering dust. Fade out. The end.

Long Term Storage facilities. They all look and act very similar. They are all miles out of town, have a nice long entry driveway through a pastoral setting that ends at a drop-off porte cochere that enters a massive building that houses 50 to 100 residents in a setting that is quite unlike the home these residents have left behind. It is far away from their social network. And, this is really the only option for a lot of people. The only option, by default, is the best option. Also by default, it is the worst....

The number of nursing homes nationwide that were cited for placing residents in "immediate jeopardy" increased by 22% from 2000 to 2006, according to a USA Today analysis of CMS records. The citations are the most serious reprimand inspectors can issue and often follow cases in which residents have been physically or sexually abused or did not receive their medications, USA Today reports. Nursing homes that are cited for immediate jeopardy may be fined or prohibited from accepting new Medicaid beneficiaries, "a major source of their income," USA Today reports.

The analysis found that inspectors in 2006 identified nearly 2,000 violations that jeopardized residents at about 850 of the 16,000 nursing homes across the U.S. Those violations account for about 6% of total violations found in nursing homes. CMS records for 2007, which are incomplete, show that more than 1,300 immediate jeopardy citations have been issued.

WASHINGTON, Nov. 15 — Lawmakers in two hearings on Thursday proposed ways to force nursing homes to provide more details about ownership and to hold those owners more accountable when problems emerge.

The hearings were prompted in part by concerns that quality at nursing homes was declining as large chains were acquired by private investment groups.

Members of the House Ways and Means Health Subcommittee and the Senate Special Committee on Aging proposed measures to require nursing homes to disclose ownership and to require regulators to release information about poorly managed homes.

Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, which regulates nursing homes, offered several initiatives to improve oversight. His suggestions included releasing the so-called special focus facility list, which identifies homes that regulators consider among the nation’s worst. That list, which will be released Dec. 1, has not been public.