New Report Reveals Improvements in Nursing Home Quality

A new report shows that America’s nursing facilities have continued to build on quality improvements reported in previous years and have achieved measurable improvements in nine out of 10 quality measures since 2009.

Data suggest these improvements positively affect the quality of care and quality of life of the 2.5 million Americans who require care from skilled nursing facilities annually, according to the report by the Alliance for Quality Nursing Home Care and the American Health Care Association.

The report used government-measured, publicly-available quality data. Independent researchers provided expert analysis on the capabilities of skilled nursing facilities, trends in skilled nursing care and the need for quality measures to effectively evaluate rehabilitation outcomes among an increasingly diverse patient population. Contributors also addressed approaches to improving care transitions and reducing hospital readmissions for Medicare beneficiaries.

In the past year, according to data from the Centers for Medicare and Medicaid Services, nursing facilities have improved in all short-stay measures, which include patient delirium, pain and pressure ulcers, and a vast majority of long-stay measures including measurable improvements in activities of daily living, high-risk pressure ulcers, resident mobility and pain.

Leading experts in quality and healthcare research contributing to this year’s report included Andrew Kramer, MD of Providigm Health and professor of medicine at the University of Colorado; Mary D. Naylor, RN, PhD, FAAN, Katherine M. Abbott, PhD, MGS and Karen B. Hirschman, PhD, MSW of the University of Pennsylvania; Mary Jane Koren, MD, MPH, with Advancing Excellence in America’s Nursing Homes; and the independent healthcare advisory firm Avalere Health.

As the largest provider of post-acute rehabilitative services in the healthcare continuum, nursing facilities have seen a dramatic shift in patients requiring short-term therapy services intended to restore function so they can ultimately return to an independent living situation, according to the report. Contributors found that current quality measures more commonly reflect the traditional role of nursing homes and do not allow for proper measurement of rehabilitation services for short-stay Medicare patients, meaning substantial change is needed in the area of nursing facility quality measures.

“Post-acute care has gravitated to a system of multiple transfers to different levels of care,” Kramer wrote. “With this evolution, it is critical that measures of rehabilitation quality follow patients across these transitions over fixed time intervals rather than during individual stays.”

The report offers a variety of recommendations for improving quality measurement and care processes, including:

• Developing and endorsing more measures related to the care provided to short-stay nursing patients, particularly measures that assess functional improvement.

• Strengthening the risk adjustment methodologies currently applied to the nursing facility measurement set.

• Designing new measures, or revising current measures, to be used across post-acute care settings.

• A paradigm shift in post-acute rehabilitation performance measurement that includes patient-reported function following rehabilitation discharge as patient function continues to change.

• Improved intervention processes for preventing readmission from nursing homes to the hospital for the more frail and complex patients discharged from SNFs.

• Transitional care approaches, proven successful in improving care among similar populations, should be made accessible to nursing home residents to assure high-value care for seniors and disabled patients in our society.

• Continued involvement in national quality improvement initiatives among all nursing facilities, which will further advance the community’s quality agenda.

The full 2011 Annual Quality report is available via an e-book at

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