Has the overall quality of care in US nursing homes improved since 1996?

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Request for Question Clarification by pafalafa-ga on 14 Jun 2005 05:06 PDT

National efforts to monitor and report on the quality of care in
nursing homes are just getting underway.  There's has not yet been any
national "report card" for care that I can see.

However, there may be trend reports in individual states.  Is there a
particular state that would be of interest to you, as an answer to
your question?  Or do you only want a national perspective?

pafalafa-ga

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Clarification of Question by martinthetexan-ga on 14 Jun 2005 20:39 PDT

Thanks for your interest in my question. 

My preference is for a national "report card".  I rarely hear our
elder law clients complaining about abuse or neglect. Collegues in
other Texas cities tell me they rarely hear complaints of abuse or
neglect.  The Internet information regarding abuse seems to quote
studies and government reports from 1999 or earlier... before the
start of Federal initiative to improve the quality of care in nursing
homes. Much of the information is presented by personal injury
attorneys who have a vested interest in painting nursing homes as
dangerous, uncaring institutions.

While it's true a number of nursing homes across the country have room
to improve, I've noticed dramatic improvement in levels of care.
But, my observations could be skewed by the population we serve
(generally middle and upper middle economic classes).

I'm wondering if the Federal initiatives to improve the quality of
nursing home care began in 2000 really has improved the overall care
people receive.

Martin,

Turns out there are at least two worthwhile and fairly recent national
reports that document improvements in the quality of nursing home
care.

The federal government has only very recently undertaken an effort to
routinely measure the quality of care at nursing homes across the
country.  Those efforts indicate that the overall quality does indeed
appear to be improving.  At the same time, the consensus also seems to
be that significant problems remain in the overall level of nursing
home care, and that further improvements are needed.  Hopefully, data
collected in the coming years will document just such improvements.

I've provided links and excerpts to the two most significant
nationwide studies of nursing home care.  You should look both of
these over in more detail, as they are both chock full of useful
information:



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http://www.qualitytools.ahrq.gov/qualityreport/browse/browse.aspx?id=5063
2004 National Healthcare Quality Report Nursing Home and Home Health
Care

Findings 

[pain management has improved]

Prevalence of Pain Among Postacute and Chronic Care Residents

--Between 2002 and 2003, pain prevalence declined 12% for postacute
residents and 39% for chronic care residents

--For chronic residents? pain, a relative decline of 46% for the
intensive group compared with a 33% decline in the nonintensive group

--For postacute residents? pain, a relative decline of 17% for the
intensive group compared with a 9% decline in the nonintensive group




[Use of physical restraints is declining]
http://www.qualitytools.ahrq.gov/qualityreport/browse/browse.aspx?id=5064

Prevalence of Physical Restraints Among Chronic Care Residents

--The percentage of chronic care residents with restraints dropped
from 9.7% in 2002 to 8% in 2003, an 18% decline

--The same Nursing Home Quality Initiative study noted above found a
relative decline of 29% in the use of restraints for the intensive
quality improvement facility group compared with a 17.6% decline among
facilities in the nonintensive group



[patient mobility is improving]
http://www.qualitytools.ahrq.gov/qualityreport/browse/browse.aspx?id=5066

Improvements in Mobility in Home Health Episodes

--Four mobility measures are used to describe how well a home health
patient can get around his or her home.

--All four measures showed statistically significant improvement
between 2001 and 2003

--The category in which most improvement occurred?2.3 percentage
points?was pain interfering with activity.


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[According to GAO (a Congressional oversight body), quality of care is
improving, but is still unacceptably poor in many facilities]
http://www.gao.gov/new.items/d03561.pdf

General Accounting Office Nursing home quality: prevalence of serious
problems, while declining, reinforces importance of enhanced oversight
July 2003


--The proportion of nursing homes with serious quality problems
remains unacceptably high, despite a decline in the incidence of such
reported problems. Actual harm or more serious deficiencies were cited
for 20 percent or about 3,500 nursing homes during an 18-month period
ending January 2002, compared to 29 percent for an earlier period.

--The magnitude of the problems uncovered during standard nursing home
surveys remains a cause for concern even though OSCAR deficiency data
indicate that state surveyors are finding fewer serious quality
problems.


--Compared to an earlier period, the percentage of homes nationwide
cited since mid-2000 for actual harm or immediate jeopardy has
decreased in over three-quarters of states?with seven states reporting
a drop of 20 percentage points or more.

--Compared to the preceding 18-month period, the proportion of nursing
homes cited for actual harm or immediate jeopardy has declined
nationally from 29 percent to 20 percent since mid-2000.14

--In contrast, from early 1997 through mid-2000, the percentage of
homes cited for such serious deficiencies was either relatively stable
or increased in 31 states.


--From July 2000 through January 2002, 40 states cited a smaller
percentage of homes with such serious deficiencies, while only 9
states and the District of Columbia cited a larger proportion of homes
with such deficiencies.

--Despite these changes, there is still considerable variation in the
proportion of homes cited for serious deficiencies, ranging from about
7 percent in Wisconsin to about 50 percent in Connecticut.


[You should have a look at Table 2 in the report, since it provides
some excellent summary detail for each state]

Table 2: Change in the Percentage of Nursing Homes Cited for Actual
Harm or Immediate Jeopardy during State Standard Surveys between the
periods January 1, 1999, through July 10, 2000, and July 11, 2000,
through January 31, 2002, by State


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I trust this information fully answers your question.  However, please
don't rate this answer until you have everything you need.  If you
would like any additional information, just post a Request for
Clarification to let me know how I can assist you further, and I'm at
your service.

All the best,

pafalafa-ga


search strategy -- Google search on [ national quality "of nursing
home care" improved 2004 ]