A long term care administrator strives to provide an exceptional level of care. So what does it mean to have a quality care nursing home?
Occasionally, social security agencies will send agents to nursing homes for social security checks.
Agencies like the CMS measure the quality of care in a nursing home through the use of several indicators—such as the Donabedian model—to evaluate the quality of care in a nursing home. The Donabedian model is made up of three components: structure, process, and outcome. The structure of a nursing home includes:
- The physical plant
- The equipment
- The staff
- The long term care EHR used in the facility
The process is how care is delivered, and the outcome is the result of the care that was delivered to a long term care resident. Together, these components are used to identify areas of improvement and the effectiveness of change once these improvements have been made.
The 3 Quality Indicators
All current quality indicators are a mix of Structure, Process, and Outcome (SPO), and they include nursing home deficiency citations used for Medicare/Medicaid certification, the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), and the National Nursing Home Quality Improvement (NNHIQ) Campaign (formerly known as the Advancing Excellence Campaign).
1. Nursing Home Deficiency Citations
Deficiency citations are written by surveyors from the state departments of health and social services or by CMS contractors after conducting an on-site visit to a nursing home. All deficiency reports are published on the Nursing Home Compare website. Before they are, though, surveyors will discuss findings with administrators and directors of nursing. They provide them with an opportunity to present documentation that will prevent a citation. Surveyors also give an exit conference in which they indicate which deficiencies will be cited.
Deficiencies are shared with the facility prior to the survey results appearing on CMS Nursing Home Compare. The state also issues CMS form 2567 fifteen days after the survey. The facility then has 10 days to write a Plan Of Correction (POC), which must be submitted back to and approved by the state. Once the POC has been approved, the facility must implement it, and the state will potentially make another visit to verify implementation.
Citations vary in terms of severity and apply to the following areas (among others):
- Quality of care
- Quality of life
- Infection control
After a nursing home is issued a citation, they are expected to correct the problems before the next survey. If a nursing home does not correct the problems identified in the citation, it may be subject to penalties such as fines, loss of Medicaid/Medicare certification, and, in the worst-case scenario, forced foreclosure of the long term care facility.
2. Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)
The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) uses quality measures to assess and compare the quality of care in skilled nursing facilities. It consists of two quality measures: the MDS-based quality measure and the CAHPS for SNFs quality measure.
The MDS-based quality measure is calculated using data from the Minimum Data Set (MDS), which is a resident assessment tool that assesses the health and functional status of residents in skilled nursing facilities. The CAHPS for SNFs quality measure, meanwhile, is based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which is a survey used to measure the quality of care from the perspective of the consumer. The SNF QRP quality measures are used to generate quality reports that the public can access on the CMS website.
3. National Nursing Home Quality Improvement (NNHIQ) Campaign
The National Nursing Home Quality Improvement (NNHIQ) Campaign is a quality improvement initiative that was launched in 2006. Previously known as the Advancing Excellence Campaign, this campaign is designed to improve the quality of care in nursing homes by focusing on:
- Medication management
- Infection prevention and control
- Residents’ rights
- Food and nutrition
- Pain management
- Staffing levels and training
Current Nursing Home Problems and Challenges
Currently, nursing home administrators are dealing with several nursing home problems and challenges, which make it harder for them to effectively run a quality care nursing home Examples of these challenges include:
- The long term care staffing crisis: The nursing home industry is facing a staffing crisis due to a number of factors, such as the low pay, high-stress levels associated with working in a nursing home, the aging of the baby boomer generation, and the retirement of a large number of nurses.
- The rise of home health: Home health is a rapidly growing industry, and it is having a major impact on nursing homes. Home health care is often seen as a cheaper and more convenient alternative to nursing home care. Also, for families not sure of how to find a quality care nursing home for their loved ones, home health is their preferred option.
- A decrease in Medicare spending and new Medicare cuts: The pandemic hit the long term care industry hard. The government was forced to divert its funds to support emergency services. As a result, Medicare physician spending plunged by as much as 14%. Furthermore, Medicare cuts are expected to greatly affect SNFs, as Medicare Part A covers SNF stays.
- Risk of financial penalties due to hospital readmissions: Nursing homes can be financially penalized if their residents are readmitted to the hospital within 30 days of being discharged. This is because it is seen as a sign that the nursing home did not provide sufficient care to prevent re-admission.
- Increased workloads due to increased resident needs: The needs of nursing home residents are constantly changing thus leading to an increased workload for nursing home staff. Staff may need to provide more hands-on care as well as more emotional support, though these are complicated by the ongoing staffing crisis.
- A loss of trust in nursing home safety: A recent survey showed that as many as 41% of respondents do not trust that nursing homes can keep their loved ones safe during a pandemic. This presents a challenge to administrators, as they need to re-establish trust and demonstrate their facility’s safety measures.
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11 Tips for New Nurses
Facilities and facility leaders can create programs that offer tips for new nurses joining their teams. If these programs are integrated into the workplace culture, they can result in a quality care nursing home. Additionally, administrators can also expect quality improvements in nursing homes’ workplace environment, as new nurses can quickly learn what is expected of them, and how they can use the facility’s care plan software.
We previously mentioned some of the nursing home problems that nursing home administrators are facing. How to deal with nursing home problems, then, is a big challenge for leaders. Tips for new nurses are a measure that can go a long way in addressing some of the nursing home challenges. These tips for new nurses are:
- Have a mentor that you regularly consult with in your facility.
- Always remain calm and don’t complain when things don’t go your way.
- Carefully observe the more experienced nurses and physicians and how they carry out their duties.
- Ask questions if you are unsure about something.
- Bond with your peers.
- Take breaks as needed to recharge.
- Establish work routines and stick with them.
- Be respectful to other staff members, and in turn, they will respect you.
- Always take notes, either by hand in a notebook or via the long term care EHR if resident-related.
- Prioritize tasks in order of importance.
- Learn how to use the nursing home software by going through the training modules.
The Importance of a Quality Care Nursing Home Software
The nursing home industry is under immense pressure to improve the quality of care amid increased scrutiny from the government, media, and the public. Nursing homes are struggling to find ways to provide quality care while also dealing with the financial challenges that come with operating a long-term care facility.
One way nursing homes can improve the quality of care is by investing in quality care nursing home software. This type of software can help streamline processes and improve communication between staff members. Additionally, a quality care nursing home software can also help new nurses familiarize with the facility’s policies and procedures.
If you are a nursing home administrator who is looking to improve the quality of care at your facility, we encourage you to contact us to learn more about our quality care nursing home software.