Category Archives: Nursing Homes & Long Term Care

Home and Community-Based Services: Public Policies to Improve Access, Costs, and Quality

Source: Charlene Harrington, Terence Ng, Stephen H. Kaye, Robert Newcomer, Center for Personal Assistance Services, January 2009

Medicaid home and community based services (HCBS) have been the focus of widespread efforts by the federal and state government to expand access. The focus of this report is to examine issues of access, cost, and quality for Medicaid HCBS programs. The trends in state Medicaid HCBS programs, target groups, participants, and expenditures are summarized. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs for HCBS. HCBS cost issues have been a primary focus of policy makers and quality problems are largely not addressed. Policy recommendations are made to improve access, costs and quality at the federal and state levels in the future.

Health Workforce Information Center

Source: Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences, Health Workforce Information Center, February 2009

The Health Workforce Information Center (HWIC) provides free access to the most recent resources on the nation’s health workforce in one easy-to-use online location. Resources available through HWIC’s Web site will help health providers, educators, researchers and policymakers around the nation develop strategies to meet future workforce demands.

Through HWIC, you can stay up-to-date with the latest health workforce news and events, and connect with experts and organizations across the country.
HWIC offers the latest:

* Health workforce programs and funding sources
* Workforce data, research and policy
* Educational opportunities and models
* News and events

Available services:

* Professionally-maintained and comprehensive online library
* E-mail news and updates
* Customized assistance from information specialists

A Facility Specialist Model for Improving Retention of Nursing Home Staff: Results From a Randomized, Controlled Study

Source: Karl Pillemer, Rhoda Meador, Charles Henderson, Jr., Julie Robison, Carol Hegeman, Edwin Graham, and Leslie Schultz, Gerontologist, Volume 48, Special Issue I , 2008

Employee retention programs for long-term care staff need to be cost-effective and evidence-based. A retention specialist (RS) situated in nursing homes is one strategy that could improve retention of certified nursing assistants (CNAs) in nursing homes.

The current article presented findings from a randomized, controlled evaluation of the Retention Specialist Program (RSP). RSP targeted systematic facility problems related to staff turnover. Data collection involved CNA interviews and measurement of turnover at 30 facilities at baseline, six months and 12 months. Facilities were randomly assigned to the treatment or control group. As part of the intervention, RSs received training on retention, provision of ongoing technical assistance, and leveraging community resources. Outcome variables were attitudes toward the facility and satisfaction and job stress.

Key Findings:

* In treatment facilities, CNA turnover rates significantly decreased from baseline to 12-month assessment as compared to control facilities.


* CNA ratings of quality of care increased from baseline to six-month assessment. Similar change was seen in quality of staff education and facility trainings.


* No changes were observed in job satisfaction or stress.

VA Health Care: Long-Term Care Strategic Planning and Budgeting Need Improvement

Source: United States Government Accountability Office, GAO-09-145, January 23, 2009

In fiscal year 2007, the Department of Veterans Affairs (VA) spent about $4.1 billion on long-term care for veterans. VA provides–through VA or other providers–institutional care in nursing homes and noninstitutional care in veterans’ homes or the community. In response to a statute, VA published in 2007 a long-term care strategic plan through fiscal year 2013. VA includes long-term care spending estimates in its annual budget justifications for Congress. These estimates are based on workload projections–the amount of care to be provided–and cost assumptions. VA has discretion in allocating appropriated funds among its medical services, such as long-term care. GAO examined (1) VA’s reporting of planned workload in its 2007 long-term care strategic plan and (2) VA’s long-term care spending estimates, including its cost assumptions and workload projections, in VA’s fiscal year 2009 budget justification. GAO analyzed budget and planning documents and interviewed VA officials.

Who are direct-care workers?

Source: Paraprofessional Healthcare Institute, January 2009

Direct-care workers provide an estimated 70 to 80 percent of the paid hands-on long-term care and personal assistance received by Americans who are elderly or living with disabilities or other chronic conditions. These workers help their clients bathe, dress, eat, and negotiate a host of other daily tasks. They are a lifeline for those they serve, as well as for families struggling to provide quality care. Direct-care workers also constitute one of the largest and fastest-growing workforces in the country, playing a vital role in job creation and economic growth, particularly in low-income communities.

Perceived Advantages and Disadvantages of Using Agency Staff Related to Care in Nursing Homes: A Conceptual Model

Source: Nicholas G. Castle, Journal of Gerontological Nursing,  Vol. 35 No. 1, January 2009
(subscription required)

Data from 3,946 nursing homes (66% response rate) were used to examine the advantages and disadvantages of using agency staff. A conceptual model showing potential reasons for the relationship between agency use and care quality was also developed. Fifty-nine percent of nursing homes used some agency staff (i.e., RNs, licensed practical nurses, nurse aides) in 2006. The conceptual model and empirical analyses show that agency staff likely influence other staff, facility operations, and residents. Administrators listed more disadvantages than advantages of using agency staff.

Long-Term Care — an Essential Element of Healthcare Reform

Source: SCAN Foundation, December 2008

Key Findings:

  • The majority of Medicaid spending is on services for long-term care users. Health reform efforts can target the healthcare needs of this population in order to strengthen Medicaid for the future.
  • Some Medicare post-acute care services may fill-in for long-term care needs. Reform efforts can consider the long-term care needs of the Medicare population in order to improve the quality and cost-effectiveness of these services.
  • Medicare and Medicaid spending for dual eligibles is largely uncoordinated and unmanaged. Innovative reform efforts can coordinate and manage these services to improve quality and reduce costs.
  • A significant amount of long-term care is privately financed and provided by informal caregivers. Reform efforts can leverage, rather than replace, these private contributions.

The Economic Crisis and Its Impact on State Aging Programs

Source: National Association of State Units on Aging, December 8, 2008

The current economic crisis has many state aging directors grappling with difficult decisions on budget cuts and reductions in services. Not since the late eighties has the economy looked as sluggish. The most challenging times in the economy increase demand for state planning, budgeting, and monitoring for services that are delivered at the community level on everything from providing assistance with heating bills to providing home delivered meals as well as all types of home health supports.

The National Association of State Units on Aging (NASUA) surveyed its members to gauge the impact of the economic downturn on aging services. The members of NASUA are the nation’s 56 officially designated state and territorial agencies on aging, often referred to as State Units on Aging (SUAs). This is the second survey on the economy that NASUA completed in 2008. The first survey was conducted in June 2008. The most recent and more extensive survey was conducted in November. Forty-four states and the District of Columbia responded to the survey.

Do Noninstitutional Long-Term Care Services Reduce Medicaid Spending?

Source: H. Stephen Kaye, Mitchell P. LaPlante and Charlene Harrington, Health Affairs, Vol. 28 no. 1, 2009
(subscription required)

From the abstract:
Medicaid spending on home and community-based services (HCBS) has grown dramatically in recent years, but little is known about what effect these alternatives to institutional services have on overall long-term care costs. An analysis of state spending data from 1995 to 2005 shows that for two distinct population groups receiving long-term care services, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

Nursing Home Compare

Source: Centers for Medicare & Medicaid Services, December 2008

From the press release:
For the first time in history, the Centers for Medicare & Medicaid Services (CMS) today released quality ratings for each of the nation’s 15,800 nursing homes that participate in Medicare or Medicaid.

Consulting with a panel of experts from academia, patient advocacy and nursing home provider groups, CMS developed the rating system based on each nursing home’s performance in three critical areas:

* Health inspection surveys. Each year state and federal surveyors conduct about 15,800 on-site, comprehensive assessments of each nursing home’s health care services and compliance with federal/state rules. These surveys are designed to help protect the health and safety of residents, including resident’s rights and general quality of life. Surveyors also conduct about 50,000 complaint investigations each year. Information from the most recent three years of survey findings were used to develop the ratings.
* Quality measures. The quality rating system uses 10 key quality measures out of the 19 that can be found on the Nursing Home Compare Web site. Areas examined include the percent of at-risk residents who have pressure ulcers (bed sores) after their first 90 days in the nursing home, the number of residents whose mobility worsened after admission, and whether residents received the proper medical care.
* Staffing information. There is strong evidence that low staffing levels can comprise the level of patient care in a nursing home and is considered an important indicator of quality. This measure reports the number of hours of nursing and other staff care per patient per day. This measure is adjusted to account for the level of illness and services required by each facility’s residents.