A collaborative model takes on the care gap, part I

A group of Michigan providers convened to address their state’s looming care gap and formed the Kent County Health Field Collaborative (HFC). Its first project: a cooperative, flexible, and resourceful program that would directly address the barriers to sustained employment per the individual staffer.
John Oberlin
Michigan’s elderly population is expected to expand during the next 25 years by more than 52%—from 1.2 million to 1.8 million. Its traditional source of new caregivers (women age 25-44) is projected to shrink by more than 10%. Across the LTC industry, the annual turnover rate among entry-level direct-care workers is estimated to be as high as 70%.

In 2004, a number of Michigan providers convened to address their state’s looming care gap and formed the Kent County Health Field Collaborative (HFC). Its first project: a cooperative, flexible, and resourceful program that would directly address the barriers to sustained employment per the individual staffer.

The Opportunity Partnership & Empowerment Network (OPEN) program has been a success and continues to expand its role and coverage area outside of Kent County. During a two-year pilot program, more than 80% of employees utilizing the program maintained their employment. All of these employees were considered at risk of losing their jobs because of inabilities to successfully manage personal challenges and work expectations. Also, two of the five participating employers cut turnover rates in half, while another company reported a drop from an average of 36% to 22%. Among the employers who initially made up the HFC, turnover rates ran as high as 58% before the program.

The program's collaborative structure keeps costs low. Collectively, the provider members, who all share the same problem of staff turnover, pay for one case worker’s salary and any expenses such as supplies and additional project work. Because the HFC is made up of long-term care, acute care, and rehab providers, payments are calculated through a utilization formula.

Latest Release Of Web-Based Quality Assurance System Assists Nursing Homes In Improving Resident Care And Quality Of Life

Nursing Home Quality, the national leader in Quality Indicator Survey (QIS) based quality assurance solutions for long-term care providers, announced the release of the latest version of abaqisTM, a web-based quality assurance system designed for use by nursing home providers to identify quality concerns and focus quality improvement efforts.

The QIS is a revised long-term care survey process utilized by the Centers for Medicare & Medicaid Services (CMS) that involves two stages of review. In Stage I, preliminary investigations are conducted through structured resident, family, and staff interviews, resident observations, record reviews, and analysis of Minimum Data Set (MDS) data.

These tasks, in combination with structured facility reviews, yield 162 Quality of Care and Quality of Life Indicators (QCIs) that are compared with defined thresholds to identify Care Areas for further investigation in Stage II of the QIS. The second stage involves in-depth quality investigations using Critical Element Pathways that address assessment, care planning, care provision, and reassessment.

The latest release of the abaqis TM system encompasses all six assessments conducted on site during Stage I of the QIS, with modules for family, staff, and resident interviews, resident observations, and census and admission record reviews. The system comprehensively guides the quality assurance efforts based on QIS concepts and processes, electronically manages the resident file, and even provides analysis of facility data based on national thresholds.

"I believe that the QIS has rendered the survey process more objective and more resident-centered," says Andrew Kramer, M.D., CEO of Nursing Home Quality. "However, the QIS software used in the survey process was developed solely for government surveyor use. The abaqis TM system is an affordable, user-friendly tool designed specifically for nursing home providers, allowing them to replicate the QIS for quality improvement purposes. At the end of the day, this system enables nursing homes to provide better care and quality of life to their residents."

OIG Reports on Government-Long Term Care Industry Roundtable

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).

Transforming Hospitals: Designing for Safety and Quality

Transforming Hospitals: Designing for Safety and Quality, a DVD from the Agency for Healthcare Research and Quality (AHRQ), reviews the case for evidence-based hospital design and how it increases patient and staff satisfaction and safety, quality of care, and employee retention, and results in a positive return on investment.

This summary discusses evidence-based design, patient safety and satisfaction, quality outcomes, staff satisfaction and retention, and cost effectiveness.

Select to order the DVD.

Select for print version (PDF File, 419 KB). PDF Help.

Washington Scrutinizes Nursing Homes

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.

Stark Announces Hearing on Trends in Nursing Home Ownership and Quality

House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) announced today that the Subcommittee will hold a hearing to examine the effect of nursing home ownership trends on nursing home quality and accountability. The hearing will take place at 10:00 a.m. on Thursday, November 15, 2007, in Room 1100, Longworth House Office Building.

In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing.