What Is Quality Care? Part 1
Feb
2
Written by:
2/2/2010 4:50 PM
Some of the perils and pitfalls to watch out for when selecting long-term care facilities.
Surely one of the most difficult issues to deal with, not only in health care but in life, is the quality of long-term care. No one wants to live in a "warehouse for the dying" and, most certainly, no one wants to send one’s parents there. The grotesque vision of nursing home corridors lined with residents strapped to geri-chairs and crying out in various stages of distress is enough to prompt that often-heard oath "never to send me to a nursing home."
It doesn’t help that most people’s basic knowledge about nursing homes come from media stories brandishing the latest personal outrage or politician’s self-righteous response. When was the last time you read or saw "good news" about a nursing home?
I am the last person to defend sub-standard nursing homes, many of which had their roots in the outrageous "Medicaid mills" of the 1960s and '70s. Along with child abuse, there is no lower form of human behavior than harming vulnerable older people. But the unvarnished bad news about nursing homes troubled me greatly during my 18 years as Editor-in-Chief of Nursing Homes Magazine. During that time I had many occasions to see and celebrate stories of exceptional management and staff dedication, even helping create a quality acknowledgment award, the Optima Award, that we presented to outstanding facilities every year (now in its 14th year). Several Optima Award winners were, in fact, for-profit facilities, thus countering the popular stereotype of greedy money-grubbers running these places; these owner/operators observed the true Capitalist Manifesto: create quality products and services, and the money will follow.
Government quality enforcement is, of course, the big story that most people read about. I’m sure that most visitors to SNAPforSeniors.com are pretty well informed about this. It is called the state survey system, sponsored by the federal government but conducted by trained state investigators. What people may be somewhat less aware of is the basic document against which state surveyors are measuring nursing home compliance: the Minimum Data Set (MDS). A casual perusal of this multi-page form would boggle many a mind — an engineering-type checklist covering virtually every step a facility takes in caring for a resident. Licensed nurses are often taken off their caregiving duties to simply maintain the paperwork — indeed, nursing homes have documentation specialists called MDS nurses or nurse assessment coordinators (NACs). The paperwork is meticulous and demanding, and facilities can pay heavily for mistakes in terms of survey deficiencies and lost money (because reimbursement is pegged to the MDS as well).
One thing about checklists: they can and do prompt a "gotcha" mentality among some survey enforcers — an uncrossed "t" or an undotted "i" can lead to a reported deficiency. State survey performance throughout the field is often erratic, depending on the experience and political motivations of the surveyors. Don’t get me wrong. Surveys do uncover very serious deficiencies in nursing homes’ performance in caregiving practices and observing residents’ rights. Even worse, it’s often the same offenders repeating the same bad behavior over and over again, a risk when "paper compliance" becomes the focus rather than real quality improvement. But still, too many facilities are tarred with the same "deficiencies" brush. And the recent "Five Star" ratings issued by the federal government have their own problems; for example, facilities that specialize in caring for especially debilitated residents can look very bad in these comparisons.
Everyone — and I mean everyone — in the know agrees that the quality documentation available for popular review is far from adequate. You cannot always believe what you see. Personal visits to facilities that interest you are therefore imperative. In my next blog, I’ll offer suggestions to help you determine real quality on these visits.
1 comment(s) so far...
I agree with you. It is very difficult to actually know how well a facility is doing with resident care. The State Surveys and Five Star ratings are all most people have to go on. My company Familiies And Seniors In Transition in Dayton Ohio runs into this problem all of the time. I work with both seniors and folks with disabilities. When asked about a facility, I tell them the two scores, but warn them that unless someone is there 24/7 it is truly hard to tell.
So while the scores might not be the best, and can divert attention to filling out forms, it is the only source of relatively objective data I know of.
Michael Dring
michael@familiesandseniors.com
By Michael Dring on
3/2/2010 1:43 PM
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