Category Archives: Nursing Homes & Long Term Care

Culture Change in a For-Profit-Nursing Home Chain: An Evaluation

Source: Leslie A. Grant, Commonwealth Fund, Volume 85, February 13, 2008

Beverly Healthcare–one of the nation’s largest nursing home chains–launched a culture change initiative in 2002, called resident-centered care (RCC). This report presents findings from a 12-month evaluation of that initiative. While most prior culture change models had been implemented by nonprofit organizations in a small number of facilities, this project marked a major departure for the culture change movement because it was the first time that a large national for-profit chain implemented culture change. The RCC initiative was successful in that it introduced new organizational practices, made improvements in resident quality of life (e.g., in choice and autonomy), and created better work environments for staff. The RCC initiative did not achieve short-term financial gains. The business case for culture change, however, should be based on long-term goals to reposition the nursing home within an evolving continuum of care.

CMS Publishes a National List of Poor-Performing Nursing Homes, Key Tool for Families Seeking Quality Care

Source: Centers for Medicare & Medicaid Services (HHS)

From press release:
The Centers for Medicare & Medicaid Services (CMS) today released the first ranking of the nation’s poor-performing nursing homes. Release of the national list of facilities, identified as special focus facilities (SFFs), is expected to offer individuals, seeking long-term health care services, and their families powerful new information when choosing nursing homes.

The creation of the list was prompted by the number of facilities that were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before). Such facilities with a ‘yo-yo’ compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

Once a facility is selected as an SFF, the state survey agency conducts twice the number of standard surveys and will apply progressive enforcement until the nursing home either (a) significantly improves and is no longer identified as an SFF, (b) is granted additional time due to promising developments, or (c) is terminated from Medicare and/or Medicaid. CMS and the state can more quickly terminate a facility that is placing residents in immediate jeopardy.

The CMS policy of progressive enforcement means that any nursing home, not just those identified as an SFF, that reveals a pattern of persistent poor quality is subject to increasingly stringent enforcement action. If problems continue, the severity of penalties will increase over time, ranging from civil monetary penalties, denial of payment for new admissions and, ultimately, removal from Medicare and/or Medicaid.

As of October 2007, there were 128 SFFs, out of about 16,000 active nursing homes. The number of SFFs in each state varies according to the number of nursing homes in the state. These nursing homes, at the time of their selection as an SFF, had survey results that were among the poorest five or 10 percent in each state.

Today’s list includes 54 facilities that are at the top of the poorest performers in those states and among those facilities that have failed to improve significantly.

Special Focus Facility Background Information (PDF; 15KB)

Special Focus Facility Public List (PDF; 16 KB)

2007 Nursing Home Action Plan (PDF; 993 KB)

Family Caregiving to the Older Population: Background, Federal Programs, and Issues for Congress

Source: Congressional Research Service

Family caregiving to older individuals in need of long-term care encompasses a wide range of activities, services, and supports. Caregiving can include assistance with personal care needs, such as bathing, dressing, and eating, as well as other activities necessary for independent living, such as shopping, medication management, and meal preparation. In addition, family caregivers may arrange, supervise, or pay for formal or paid care to be provided to the care recipient.

Family caregivers fulfill the majority of the need for long-term care by older persons with chronic disabilities in the United States. As a result of increases in life expectancy, as well as the aging of the baby-boom generation, demand for family caregiving to the older population is likely to increase. However, demographic trends such as reduced fertility, increased divorce rates, and greater labor force participation among women may limit the number of available caregivers to older individuals, as well as the capacity for caregivers to provide needed care.

Although many family caregivers find caregiving for an older family member a rewarding experience, other life circumstances, in addition to caregiving, may increase caregiver stress. For example, family members may not live in close proximity to the care recipient, they may face the competing demands of child care and elder care, and they may have to manage work with caregiving responsibilities. As a result, family caregiving can lead to emotional and physical strain and financial hardship. These effects are more likely to be felt among those caring for persons with high levels of disability or cognitive impairment. Caregiver stress has been linked to nursing home admission for the care recipient, thus interventions that can reduce stress may also reduce nursing home placement.

Recognizing family caregivers as an important part of the nation’s long-term care delivery system, the federal government has established programs and initiatives that provide direct supports to caregivers, such as respite care, education and training, tax relief, and cash assistance. These benefits are targeted at family caregivers to reduce stress and financial hardship, and to improve caregiving skills, among other things. Other federal programs and initiatives provide home- and community-based long-term care services and supports to the care recipient. These programs can indirectly benefit caregivers in relieving caregiver burden by either supplementing the informal care they are providing or substituting with paid support.

Three sets of policies that would provide direct assistance to family caregivers to older adults are briefly discussed in the last section of this report. These policy issues, which have been the subject of discussion among federal policymakers and other interested stakeholders, include the following: caregiver services and supports, flexible workplace accommodations and income security, and additional tax credits.

The FLSA Minefields Await the Unwary LTC Employer

Source: John E Lyncheski, Nursing Homes: Long Term Care Management, Vol. 56 no. 7, July 2007

Misunderstood or misapplied provisions of the Department of Labor’s regulations can have explosive consequences. The Department of Labor has long-term care in its sights for nonexempt employee overtime infractions.

A Health Link Hits Home

Source: Healther Kleba, Governing, Vol. 20 no. 6, March 2007

A handful of large and small telehealth programs are finding that remote monitoring can curb the costs of long-term care.

Although there are obstacles to widespread use–mostly in terms of upfront costs and patients’ acceptance–the technology is in place and the benefits are becoming clear. While the Alabama program is one of only a handful of experimental state and local efforts, there is already an impressive track record on remote monitoring. The U.S. Department of Veterans Affairs has been practicing telehealth for nearly five years, and the results suggest that the program could lower the cost of treating long-term and chronic-care patients. VA officials report that home-care monitoring has been cutting by about one-third the patient-care costs of those who are remotely monitored.