Quality of Care in Nursing Homes Statistics

Understanding Nursing Home Quality

When it comes to nursing home care, understanding the quality provided is essential for individuals and their families. The quality of care in nursing homes is a complex concept influenced by various factors, including regulations, facility characteristics, and staffing levels. In this section, we will explore the Five-Star Quality Rating System and the factors that influence the quality of care in nursing homes. Here are some key statistics that highlight the current state of quality of care in U.S. nursing homes:

• Staffing levels: According to the Centers for Medicare & Medicaid Services (CMS), the average nursing home provides 3.9 hours of nursing care per resident per day. However, many experts recommend a minimum of 4.1 hours per resident per day to ensure adequate care.
• Pressure ulcers: Pressure ulcers, also known as bed sores, are a common problem in nursing homes. The CMS reports that 7.3% of long-stay nursing home residents had pressure ulcers that were new or worsened in 2019.
• Falls: Falls are another major concern in nursing homes. According to the Agency for Healthcare Research and Quality (AHRQ), between 50-75% of nursing home residents fall each year. This is twice the rate of falls among older adults living in the community.
• Antipsychotic medication use: The overuse of antipsychotic medications in nursing homes is a serious issue. In 2019, the CMS found that 14.3% of long-stay nursing home residents received an antipsychotic medication, despite not having a diagnosed condition that would warrant their use.
• Infection control: Infections are a leading cause of morbidity and mortality in nursing homes. The COVID-19 pandemic has highlighted the importance of infection control practices. A study published in the Journal of the American Geriatrics Society found that nursing homes with higher RN staffing levels had lower rates of COVID-19 cases and deaths.

Five-Star Quality Rating System

To assist consumers, their families, and caregivers in making informed decisions, the Centers for Medicare & Medicaid Services (CMS) developed the Five-Star Quality Rating System for nursing homes. This rating system assigns a rating between 1 and 5 stars to nursing homes, with 5 stars indicating much above average quality and 1 star indicating much below average quality.

The Five-Star Quality Rating System evaluates nursing homes based on three main domains: health inspections, staffing, and quality measures. Health inspections assess compliance with federal regulations and identify any deficiencies. Staffing measures the number of hours of direct care provided to residents by nursing staff. Quality measures focus on specific aspects of care, such as pain management and resident satisfaction. These domains are then combined to calculate an overall star rating for each nursing home.

It is important to note that while the Five-Star Quality Rating System provides valuable information, it is just one tool for comparing nursing homes. It is recommended to consider other factors, such as location, services offered, and personal preferences, when making decisions about nursing home care.

Factors Influencing Quality

Various factors influence the quality of care in nursing homes. Structural variables, such as staffing levels and facility characteristics, play a crucial role in measuring nursing home quality. Staffing levels, in particular, have been extensively studied in relation to quality of care.

Studies have shown that higher nursing staff levels, including registered nurses (RNs), are associated with improved patient outcomes and higher quality of care. A landmark study found that a higher ratio of RN hours per patient was consistently associated with improved patient survival, functional status, and discharge from the nursing home.

Additionally, compliance with regulations, workforce shortages, and challenges in meeting the diverse needs of residents present ongoing challenges in maintaining and improving the quality of care in nursing homes. These factors highlight the importance of ongoing monitoring and evaluation to ensure that nursing homes meet the necessary standards and provide optimal care to their residents.

Understanding the Five-Star Quality Rating System and the factors that influence quality can help individuals and their families make informed decisions when choosing a nursing home. By considering multiple aspects of care, including staffing levels and compliance with regulations, individuals can strive to find a nursing home that provides high-quality care for their specific needs.

Impact of Staffing on Care

The staffing levels in nursing homes play a significant role in determining the quality of care provided to residents. Higher nursing staff levels, especially those of registered nurses (RNs), have been associated with improved quality of care and better patient outcomes in nursing facilities.

Importance of Nursing Staff Levels

Research studies have consistently shown that higher nursing staff levels in nursing homes are linked to better quality of care. Specifically, studies have found that higher nursing staff levels, measured in terms of nursing staff hours per resident day, are associated with improved care processes and outcomes.

A landmark study found that a higher ratio of RN hours per patient was consistently and significantly associated with improved patient survival, functional status, and discharge from the nursing home. The study also revealed that higher RN intensity was associated with a lower rate of mortality.

The configuration, or staff mix, of nursing personnel is also crucial in influencing nursing home quality. It is not solely the total nursing hours that impact quality, but the composition of the staff. Having an appropriate ratio of RNs to other nursing staff members is essential for achieving optimal care outcomes.

Role of Registered Nurses (RNs)

Registered nurses (RNs) play a vital role in nursing home care. They are highly trained healthcare professionals who are responsible for coordinating and providing direct patient care. RNs bring specialized knowledge and skills to ensure the delivery of safe and effective care to residents.

RNs are involved in various aspects of care, including assessing residents' health conditions, developing personalized care plans, administering medications, monitoring vital signs, and providing emotional support. They collaborate with other healthcare professionals, such as physicians and therapists, to coordinate comprehensive care for residents.

The presence of RNs in nursing homes has been associated with improved patient outcomes. Studies have shown that higher RN staffing ratios are linked to reduced mortality rates, improved functional status, and better overall quality of care.

By prioritizing adequate nursing staff levels, particularly RNs, nursing homes can enhance the quality of care provided to residents. The presence of skilled and qualified nursing staff ensures that residents receive the appropriate attention, support, and medical expertise necessary for their well-being.

Recent Changes in Quality Ratings

The quality ratings of nursing homes are subject to ongoing evaluation and refinement. In recent years, there have been notable changes to the rating system to provide a more comprehensive assessment of the quality of care. Two significant updates include the addition of staff turnover measures and the impact of the COVID-19 pandemic.

Addition of Staff Turnover Measures

Recognizing the crucial role of staffing in delivering quality care, the Centers for Medicare and Medicaid Services (CMS) introduced the addition of staff turnover measures to the Nursing Home Five Star Quality Rating System. A QSOG Memo (QSO-22-08-NH) posted on January 7, 2022, outlined the implementation of these measures, which will be incorporated into the rating system in July 2022 [1].

Staff turnover measures aim to assess the stability and continuity of staffing within nursing homes. High turnover rates can negatively impact the quality of care provided, as it may lead to inconsistencies in resident-staff relationships and disrupt continuity of care. By including staff turnover measures in the rating system, it provides a more comprehensive understanding of the staffing dynamics within nursing homes and their potential impact on care quality.

COVID-19 Pandemic Impact

The COVID-19 pandemic had a significant impact on nursing homes across the United States. By August 2020, nearly half of COVID-related deaths in the country occurred in nursing homes and assisted living facilities [3]. The pandemic disproportionately affected nursing homes serving a higher percentage of non-White residents, leading to more cases and deaths compared to those serving primarily White residents.

The staffing challenges faced by nursing homes were exacerbated during the pandemic. Many facilities struggled with workforce shortages and high rates of turnover, which further strained their ability to provide quality care. According to research, as many as 95 percent of nursing facilities in the US are understaffed. Daily staffing levels varied greatly by facility and often fell below recommended levels, with over 30 percent of facilities reporting staffing shortages between September and October 2021.

However, the introduction of vaccines in late December 2020 greatly alleviated the impact of COVID-19 in nursing homes. Vaccination rates in nursing homes surpassed the national average, particularly in nonprofit and nonchain facilities. Race and ethnicity also influenced vaccination rates among residents and staff.

The COVID-19 pandemic highlighted the importance of infection control protocols, emergency preparedness, and the resilience of nursing homes in maintaining the quality of care in challenging circumstances. It underscored the need for ongoing vigilance and support to ensure the safety and well-being of residents and staff alike.

As the field of nursing home care continues to evolve, quality ratings will adapt to reflect the changing landscape and address emerging challenges. The incorporation of staff turnover measures and the recognition of the impact of the COVID-19 pandemic are essential steps in providing a more comprehensive assessment of the quality of care in nursing homes.

Quality Indicators in Nursing Homes

Ensuring quality of care in nursing homes is of utmost importance for the well-being and safety of residents. Various indicators are used to assess and improve the quality of care provided by nursing homes on a national scale. In this section, we will explore two key quality indicators: deficiency citations and the Facility Quality Indicator Profile.

Deficiency Citations

Deficiency citations are one of the key quality indicators used in nursing homes to identify areas where care may fall short of regulatory standards. These citations are issued by regulatory agencies during inspections and surveys. They highlight violations of federal or state regulations and serve as a mechanism for holding nursing homes accountable for the quality of care they provide.

Deficiency citations can range from minor infractions to more serious violations that pose a risk to the health and safety of residents. They encompass a wide range of areas, including medication management, infection control, resident rights, staff training, and more. Nursing homes are required to address these deficiencies and develop plans of correction to ensure compliance with regulations.

Facility Quality Indicator Profile

The Facility Quality Indicator Profile is another important tool used to assess the quality of care in nursing homes. This report provides a comprehensive overview of a nursing home's performance in various quality measures. It includes information on staffing levels, resident outcomes, and other important indicators.

The Facility Quality Indicator Profile incorporates data from the Nursing Home Compare website, which is a resource used by consumers and healthcare professionals to compare nursing homes based on quality measures. This profile enables stakeholders to gain insights into a nursing home's strengths and areas for improvement, allowing for informed decision-making regarding care options.

By examining measures such as staffing ratios, rates of pressure ulcers, falls, and other quality indicators, the Facility Quality Indicator Profile helps identify areas where nursing homes excel and areas that may require attention. This information is invaluable in monitoring and improving the quality of care provided by nursing homes.

It is important to note that deficiency citations and the Facility Quality Indicator Profile are just a few of the many quality indicators used to assess nursing home care. These indicators, along with others such as Nursing Home Compare and the Advancing Excellence Campaign, play a critical role in influencing provider behavior, consumer choices, and regulatory oversight.

By consistently monitoring and addressing deficiencies and utilizing comprehensive quality indicator profiles, nursing homes can strive to provide the highest quality of care to their residents. These indicators help drive continuous quality improvement efforts and ensure that nursing home residents receive the care they deserve.

Challenges in Nursing Home Care

Providing quality care in nursing homes poses several challenges that impact the well-being of residents. Two significant challenges are workforce shortages and compliance with regulations.

Workforce Shortages

Nursing homes often face staffing shortages, which can have detrimental effects on the quality of care provided. Research indicates that as many as 95 percent of nursing facilities in the U.S. are understaffed [4]. Insufficient staffing levels can lead to decreased attention and care for residents, resulting in potential neglect and compromised health outcomes.

Understaffing in nursing homes is a long-standing issue that has been recognized since the 1980s. It is crucial to address workforce shortages by attracting and retaining qualified healthcare professionals who are dedicated to providing high-quality care to nursing home residents.

Compliance with Regulations

Compliance with regulations is another challenge in nursing home care. Nursing homes must adhere to a variety of state and federal regulations to ensure the safety and well-being of residents. These regulations cover areas such as staffing requirements, infection control, medication management, resident rights, and more.

Maintaining compliance with these regulations can be complex and demanding. Failure to meet regulatory standards can negatively impact the quality of care provided to residents and may result in penalties or legal consequences. It is essential for nursing homes to have robust systems in place to monitor and ensure ongoing compliance with regulatory requirements.

By addressing workforce shortages and maintaining strict compliance with regulations, nursing homes can strive to provide the highest quality of care to their residents. Efforts to improve the intensity of professional nursing staff, particularly registered nurses (RNs), have been found to have a direct impact on resident outcomes such as mortality and functional status [2]. It is important for nursing homes to prioritize adequate staffing levels and dedicate resources to meet regulatory standards, creating an environment that promotes the well-being and safety of residents.

Public Perception of Nursing Home Care

When it comes to public perception, Americans have varying views on the quality of care provided in nursing homes. These perceptions are shaped by factors such as personal experiences, media coverage, and overall awareness of the industry. In this section, we will explore Americans' views on quality and their concerns about safety in nursing homes.

Americans' Views on Quality

According to a survey conducted by Gallup, nursing homes receive an average grade of D+ for quality of care. More than four in 10 U.S. adults grade nursing homes negatively, with 36% giving them a "D" (poor) and 6% assigning an "F" (fail) grade. Only 1% rate nursing homes as excellent "A" and 8% as good "B" [6].

This data highlights the general dissatisfaction with the overall quality of care in nursing homes. Many Americans express concerns about the standards and practices within these facilities, contributing to the negative perception.

Concerns About Safety

Safety is a significant concern for nursing homes, as indicated by the Gallup survey. Only 26% of Americans consider nursing homes to be safe places for older adults in the U.S. Furthermore, more than four in 10 U.S. adults (42%) believe that nursing homes are not very or not at all effective in keeping residents safe from avoidable harms such as infections, pressure wounds, abuse, and neglect.

The survey also found that a majority of Americans would feel uncomfortable being admitted to a nursing home if they could no longer care for themselves. Similarly, many individuals expressed discomfort with the idea of admitting a relative or family member into such a facility.

It is worth noting that more women than men cite quality and personal safety concerns regarding nursing homes, while men are more likely to fear losing their independence or dying there. These gender differences further contribute to the varied perceptions of nursing home care.

Overall, the survey conducted by West Health and Gallup indicates that Americans are largely uncomfortable with the thought of needing a nursing home in their later years or using one for family. This low confidence in the ability of nursing homes to keep residents safe and provide quality care shapes the public perception of nursing home care.

References

• ‍https://www.ncbi.nlm.nih.gov/books/NBK584647/‍
• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915498/
• https://www.ncbi.nlm.nih.gov/books/NBK584660/
• https://www.cms.gov/medicare/quality/nursing-home-improvement
• https://www.ncbi.nlm.nih.gov/books/NBK217548/