A new survey of state laws around dementia training reveals a patchwork of requirements and standards across settings, professional licensure and personnel. It found that existing laws and training are not keeping up with the growing needs of people who are cognitively impaired.
Potentially Avoidable Hospitalizations (PAH) among nursing home residents are costly, expose residents to additional health risks and exact a toll on patients and families. Many of these readmissions occur after hours or on weekends — when there is no physician or nurse practitioner readily available.
PAHs are hospitalizations that could have been avoided because the condition could have been prevented or treated outside of an inpatient hospital setting. One skilled nursing home chain is using a novel telemedicine program to bring board-certified physicians to the patient bedside, providing two-way video communication to assess, diagnosis and minimize readmissions. It may also save the health system hundreds of thousands of dollars every year. Continue reading
Elder abuse was a key agenda item at this year’s White House Conference on Aging (WHCoA). While much of that panel discussion focused on financial exploitation, this is only one type of abuse that an older person might suffer.
Liz Seegert’s new tip sheet discusses how many seniors have suffered from some kind of abuse – the numbers are alarming – as well as what constitutes abuse, factors that make seniors vulnerable and common signs of abuse.
For reporters, Seegert offers a list of story ideas, resources and contact information for potential sources for those writing about elder abuse.
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
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.
- Using Nursing Home Compare
- Finding patterns and trends in health data: Pivot tables in spreadsheets
- Intro to investigating health data using spreadsheets
- Covering the Health of Local Nursing Homes
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.