We tend to focus on the Affordable Care Act as a law that simply gives more people health insurance – and it has.
But as we’ve noted before, the health reform law also contains all sorts of programs and provisions that aim to change how health care is delivered: how we pay, what we pay for, and how we shift from a hospital-centric acute care system to one that stresses prevention, wellness and care and management of chronic diseases. Examples can be found across the country.
At a recent AHCJ webinar, Patrick Conway, M.D., deputy administrator of the Center for Medicare and Medicaid Services, gave an overview of some of the changes underway. Conway, whose job includes oversight of the Center for Medicare and Medicaid Innovation, also announced the next big thing in Accountable Care Organizations. More on that below. Continue reading
Like the United States, most European nations face an increasingly aging population, with more elderly living in some type of long-term care facility or nursing home. A new study in the March 12 online issue of the European Respiratory Journal indicates that indoor air quality in these nursing homes has a serious effect on the lung health of elderly residents.
The research describes the negative effects of poor air quality in nursing homes across several countries. U.S. journalists may want to use this study as background to investigate similar issues at nursing homes in their communities.
Investigators from the EU-funded Geriatric study in Europe on health effects of air quality in nursing homes (GERIE) collected data on five indoor air pollutants: particulate matter known as PM10 (large particles) and PM0.1 (ultra-fine particles), formaldehyde, nitrogen dioxide and ozone. These pollutants come from a range of sources including heaters, building materials, furniture, cleaning products, disinfectants and cooling systems. They studied levels of the pollutants at 50 nursing homes in seven countries: Belgium, Denmark, France, Greece, Italy, Poland and Sweden. Continue reading
Infections among nursing home residents are rising, according to a study presented Oct. 8, 2014, at IDWeek (an international gathering of experts in infectious disease and epidemiology).
Researchers from Columbia University School of Nursing and RAND Corporation analyzed infections in nursing homes over a five-year period from 2006-2010, using Minimum Data Set assessment data – the information submitted by the facilities to the Centers for Medicare and Medicaid. They found significantly increased infection rates for pneumonia, urinary tract infections (UTIs), viral hepatitis, septicemia, wound infections, and multiple drug-resistant organisms (MDROs), conditions that raise the risk of complications and death. Only tuberculosis rates did not show an increase.
Approximately 1.6 million to 3.8 million infections occur among U.S. nursing home residents each year. The new study found that UTIs remain, by far, the most frequently reported type of infection, but they also showed the smallest rise in prevalence – just 1 percent. Pneumonia was the second most common infection, and its prevalence rose 11 percent from 2006 to 2010. Infection rates increased 69.7 percent for viral hepatitis, 25.2 percent for septicemia, 24.1 percent for pneumonia, 15.7 percent for MDRO and 4.6 percent for wound infections.
AHCJ’s latest update to nursing home inspection data gives members three years of the most severe deficiencies found during inspections and the current star ratings assigned by the U.S. Centers for Medicare and Medicaid Services.
The data could be a good starting point for reporters who want to pursue authoritative stories about their local nursing homes.
The data now contains 16,806 such deficiencies as recorded by CMS. Deficiencies are characterized by their severity, “A” being the least severe and “L” being the most severe. AHCJ pruned down the data to include just the most severe of the deficiencies, letters “G” through “L.” These range from an “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety.”
Under its star rating system, CMS gives nursing homes between one and five stars. According to the CMS ratings web site “nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.” Each nursing home is given an overall rating, as well as three specific ratings: health inspections, staffing and quality measures.
The AHCJ version of nursing home data is derived from a large file that is split up for easier use by members.
Every year, the Centers for Medicare & Medicaid issues a list of troubled nursing homes as part of its Special Focus Facility Initiative. CMS released an updated list on June 19 as a PDF and AHCJ has posted the list as a series of web pages and has made them available to download as Excel spreadsheets.
The initiative is intended to address nursing homes that cycle in and out of compliance. Homes in this program are visited by survey teams twice as frequently as other nursing homes. This list includes nursing homes added to the SFF initiative and updates the status of homes already in the program.
This year, 15 homes in 14 states were added to the list. Sixteen others were found to have “failed to show significant improvement,” 23 were deemed to have shown improvement, 33 have “graduated” from the program and four are no longer participating in Medicare/Medicaid.
Angelo Fichera of The Philadelphia Inquirer recently reported on one nursing home that will likely close after spending three years in the SFF Initiative, noting that CMS has not seen an improvement in care:
CMS expects that after two years on the watch list, nursing homes will either improve and “graduate” from the program; have funding terminated; or be granted an extension to improve because of “promising progress,” according to the agency.
To round out your reporting on nursing homes, AHCJ just updated its version of CMS’s Nursing Home Compare database, which includes details of the most severe deficiencies found during nursing home inspections for the past three years. AHCJ posted separate files covering the star ratings for nursing homes – from 1 to 5 – based on quality, inspection results, staffing and overall ratings.
Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.
For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes. Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.
Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Continue reading
A new data brief from the National Center for Health Statistics compares residential care communities with and without special dementia care units in 2010. About four in 10 residents (42 percent) living in residential care communities had Alzheimer’s disease or another dementia. Some states have specific requirements for residential care for these patients such as locked doors and specially trained staff.
Among the major findings:
- 17 percent of residential care communities in the U.S. Had special dementia care units in 2010
- Beds in these special units accounted for 13 percent of all residential care beds
- Facilities with special dementia care units were more likely to be chain-affiliated and built specifically as a residential care community, and less likely to be certified or to participate in Medicaid.
- At least seven out of 10 residential care communities with dementia special care units had features such as specially trained staff (88 percent), an enclosed courtyard (82 percent), doors with keypads or electronic keys (79 percent), and locked exit doors (76 percent).
- More residential communities with dementia care units were located in the Northeast or a metropolitan statistical area and less likely to be situated in the western U.S.
There are some helpful charts to put the data in visual perspective. Reporters may want to see how local residential facilities compare to the national data, or use these figures in combination with a story like this one from KSWB-San Diego – on how a daughter decided her parents needed to move to a care facility.
Alaska is the place to be if you need nursing home care, but steer clear of Texas. Families for Better Care, a Florida-based nursing home resident advocacy group, published a new state-by-state nursing home report card which aggregates data from several key measures.
The group scored, ranked and graded states on eight different federal quality measures ranging from the percentage of facilities with severe deficiencies to the number of hours frontline caregivers averaged per resident per day. The organization analyzed results of staffing data compiled by the Kaiser Health Foundation, performance measures from the Center for Medicare and Medicaid Services’ Nursing Home Compare database, and the Office of State Long-Term Care Ombudsman complaint data to come up with the final grades.
The best nursing home states are Alaska, Rhode Island and New Hampshire; Texas, Louisiana and Indiana were at the bottom.
Other results included:
- More professional nursing staff are needed – Only seven states provided more than one hour of professional nursing care per resident per day.
- An overwhelming lack of staffing – 96 percent of states offered residents fewer than three hours of direct resident care per day.
- Widespread abuse and neglect – One in five nursing homes abused, neglected or mistreated residents in almost half of all states.
This is another good opportunity to review the list of nursing homes in your state and compare results. There are numerous story angles that can work here – for example, which nursing home ranks best/worst in your state and why? Are administrators doing anything to correct deficiencies? Are state officials aware of these problems? What, if any, action is being taken? What do family members think?
The 2013 Nursing Home Report Card is available for download.
It was worth the wait to attend one of the last sessions on the last day of Health Journalism 2013.
Data mining is one of those topics that can make the audience’s eyes glaze over, but the energy level in the room was high as the audience learned how two Boston Globe reporters used publicly accessible records to expose widespread overmedication of Massachusetts nursing home residents, resulting in a highly acclaimed front-page series.
Health reporter Kay Lazar led a panel which included her colleague, reporter Matt Carroll, and Patricia Fried, a consultant to lawyers investigating nursing home wrongdoing, subcontractor to the Centers for Medicare and Medicaid Services, and experienced nursing home director.
Discovering the truth about nursing home residents’ quality of life can be challenging, Lazar said. However, once you understand what to look for and how to analyze the data, it unearths a wealth of information, and many potential story ideas. Much of the analysis conducted by Lazar and Carroll came from statements of deficiency (SOD) forms submitted to CMS by nursing home surveyors, also known as inspectors. Continue reading
It’s well known that older adults are more vulnerable in times of natural disaster. But there’s nothing like a storm the size of Sandy to drive this point home.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to email@example.com.
In the past week, we’ve read about New York City hospitals and nursing homes that decided to wait out the storm rather than evacuating. Sheri Fink, who won a Pulitzer Prize for her report on decisions made at Memorial Medical Center in the wake of Hurricane Katrina, got out ahead of Sandy and talked to city and state health officials as well as facility executives. Her ProPublica story is must-reading for anyone who wants to understand the thinking of officials responsible for preparing for the storm.
A take-home point: Evacuations can be extremely difficult for frail seniors living in nursing homes. Balancing the potential impact of displacing residents against the potential impact of sheltering in place during a storm isn’t easy.
I hope that reporters writing these kinds of Sandy-related stories take this into account. For another look at decisions made by city and state decisions vis a vis nursing homes, see this piece by Ben Hallman in the Huffington Post. Kudos to this reporter for going out during the storm and going to a site where nursing home residents were being sheltered. Continue reading