Advertisement

Calling all nurses—Now is the time to take action on improving the quality of care in nursing homes

Published:January 06, 2023DOI:https://doi.org/10.1016/j.outlook.2022.11.001

      Highlights

      • The NASEM Committee on the Quality of Care in Nursing Homes provided seven goals and associated recommendations to transform nursing home care.
      • The seven goals address areas in which nurses have tremendous expertise and leadership including delivery of whole person care, workforce development, transparency and accountability, health care financing, and quality assurance.
      • Nurses must take action to ensure these recommendations are implemented.

      Abstract

      For a number of decades, nurses have raised concerns about nursing-related issues in nursing homes (NH) such as inadequate registered nurse (RN) staffing, insufficient RN and advanced practice registered nurse (APRN) gerontological expertise, and lack of RN leadership competencies. The NASEM Committee on the Quality of Care in Nursing Homes illuminated the long-standing issues and concerns affecting the quality of care in nursing homes and proposed seven goals and associated recommendations intended to achieve the Committee's vision: Nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses the benefits and risks of care and treatments. This paper outlines concrete and specific actions nurses and nursing organizations can take to ensure the recommendations are implemented

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Alexander G.L.
        • Georgiou A.
        • Doughty K.
        • Hornblow A.
        • Livingstone A.
        • Doughtery M.
        • Fisk M.
        Advancing health information technology roadmaps in long term care.
        International Journal of Medical Informatics. 2020; 136https://doi.org/10.1016/j.ijmedinf.2020.104088
        • Alexander G.L.
        • Rantz M.
        • Galambos C.
        • Vogelsmeier A.
        • Flesner M.
        • Popejoy L.
        • Elvin M.
        Preparing nursing homes for the future of health information exchange.
        Applied Clinical Informatics. 2015; 6: 248-266https://doi.org/10.4338/ACI-2014-12-RA-0113
        • Antwi Y.A.
        • Bowblis J.R.
        The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the great recession.
        American Journal of Health Economics. 2018; 4: 131-163
        • Bostick J.E.
        • Rantz M.J.
        • Flesner M.K.
        • Riggs C.J.
        Systematic review of studies of staffing and quality in nursing homes.
        Journal of the American Medical Directors Association. 2006; 7: 366-376
      1. Bureau of Labor Statistics. (n.d.). May 2020 national industry-specific occupational employment andwageestimates: NAICS 623100—Nursing care facilities (skilled nursing facilities). Accessed April 25, 2022. https://www.bls.gov/oes/current/naics4_623100.htm

      2. Bureau of Labor Statistics. (n.d.). 2018 SOC definitions. Accessed April 25,2022. https://www.bls.gov/soc/2018/soc_2018_definitions.pdf

      3. CAHPS, (n.d.). Retrieved June 18, 2022 from https://www.ahrq.gov/cahps/index.html

      4. Center for Medicare Advocacy. 2014. Staffing deficiencies in nursing facilities: Rarely cited, seldom sanctioned. Retrieved June 19, 2022 from https://medicareadvocacy.org/staffing-deficiencies- in-nursing-facilities-rarely-cited-seldom-sanctioned/

      5. Centers for Medicare and Medicaid Services. 2019. National health expenditures 2019: Highlights. Retrieved from https://www.cms.gov/files/document/highlights.pdf

      6. CMS (Centers for Medicare and Medicaid Services). 2003. Nursing home quality initiative overview. https://www.medicare.gov/care-compare/?providerType=NursingHome&redirect=true (accessed July 29, 2021).

        • CMS
        Centers for Medicare and Medicaid releases telehealth toolkit for general practitioners and end-stage renal disease (ESRD) providers.
        CMS, Baltimore, MD2020 (Retrieved April 16, 2020 from)
        • Cooke H.A.
        • Baumbusch J.
        Not just how many but who is on shift: The impact of workplace incivility and bullying on care delivery in nursing homes.
        The Gerontologist. 2021; 61: 563-572
        • Cormi C.
        • Chrusciel J.
        • Fayol A.
        • Rechem M.
        • Aboa-Amsha K.
        • Tixier M.
        • Lewkowicz M.
        • Laplanche M.
        • Sanchez S.
        The use of telemedicine in nursing homes: A mixed-method study to identify critical factors when connecting with a general hospital.
        International Journal of Environmental Research in Public Health. 2021; 18: 11148https://doi.org/10.3390/ijerph182111148
        • Cross D.A.
        • McCullough J.S.
        • Banaszak-Holl J.
        • Adler-Milstein J.
        Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions.
        Health Services Research. 2019; 54: 1335-1345https://doi.org/10.1111/1475-6773.13210
      7. DHHS. (April 20, 2022. HHS releases new data and report on hospital and nursing home ownership. DHSS press release. https://www.cms.gov/newsroom/press-releases/hhs-releases-new-data-and-report-hospital-and-nursing-home-ownership

        • Doucette J.N.
        • Pabico C.
        Nursing management partners with ANCC's pathway to excellence® program.
        Nursing Management. 2018; 49: 13-15
      8. Drake, A. 2020. Direct care work is real work: Elevating the role of the direct care worker. PHI. Retrieved June 18, 2022 from http://www.phinational.org/resource/direct-care-work-is-real-work-elevating-the-role-of-the-direct-care-worker/

        • Gandhi A.
        • Yu H.
        • Grabowski D.C.
        High nursing staff turnover in nursing homes offers important quality information.
        Health Affairs. 2021; 40: 384-391https://doi.org/10.1377/hlthaff.2020.00957
        • GAO (U.S. Government Accountability Office)
        Poorly performing nursing homes: Special focus facilities are often improving, but CMS's program could be strengthened.
        U.S. Government Accountability Office, Washington, DC2010 (Retrieved June 28, 2022 from)
        • GAO
        Medicare and medicaid participating facilities: CMS needs to reexamine its approach for funding state oversight of health care facilities.
        Government Accountability Office, Washington, DC: U.S2009
        • Godby T.
        • Saldanha S.
        • Valle J.
        • Paul 3rd, D.P.
        • Coustasse A.
        Is there a trade-off between quality and profitability in United States nursing homes?.
        The Health Care Manager. 2017; 36: 140-146https://doi.org/10.1097/HCM.0000000000000151
        • Gorges R.J.
        • Konetzka R.T.
        Factors associated with racial differences in deaths among nursing home residents with COVID-19 infection in the U.S.
        JAMA Network Open. 2021; 4e2037431https://doi.org/10.1001/jamanetworkopen.2020.37431
      9. Gupta, A., Howell, S. T., Yannelis, C., & Gupta, A. 2021. Does private equity investment in healthcare benefit patients? Evidence from nursing homes. (Working Paper 28474). Retrieved from https://www.nber.org/system/files/working_papers/w28474/w28474.pdf

        • Hawk T.
        • White E.M.
        • Bishnoi C.
        • Schwartz L.B.
        • Baier R.R.
        • Gifford D.R.
        Facility characteristics and costs associated with meeting proposed minimum staffing levels in skilled nursing facilities.
        Journal of the American Geriatrics Society. 2022; 70: 1198-1207https://doi.org/10.1111/jgs.17678
        • IOM (Institute of Medicine)
        Improving the quality of care in nursing homes.
        National Academy Press, Washington, D.C.1986
        • IOM
        Nurse staffing in hospitals and nursing homes: Is it adequate?.
        National Academy Press, Washington, D.C.1996
        • IOM
        Improving the quality of long-term care.
        National Academy Press, Washington, D.C.2001
        • IOM
        Retooling for an aging America: Building the health care workforce.
        The National Academies Press, Washington, DC2008https://doi.org/10.17226/12089
      10. LTCCC. 2021. Nursing home Medicaid funding: Separating fact from fiction. Retrieved from https://nursinghome411.org/wp-content/uploads/2021/01/LTCCC-Policy-Brief-Medicaid-Funding-Facts-vs-Fiction.pdf

        • Martin A.B.
        • Hartman M.
        • Lassman D.
        • Catlin A.
        National health care spending in 2019: Steady growth for the fourth consecutive year.
        Health Affairs (Project Hope). 2021; 40: 14-24https://doi.org/10.1377/hlthaff.2020.02022
        • McGilton K.S.
        • Escrig-Pinol A.
        • Gordon A.
        • Chu C.
        • Zuniga F.
        • Sanchez M.
        • Bowers B.
        Uncovering the devaluation of nursing home staff during COVID-19: Are we fuelling the next health care crisis?.
        Journal of the American Medical Directors Association. 2020; 21: 962-965https://doi.org/10.1016/j.jamda.2020.06.010
        • Mor V.
        • Zinn J.
        • Angelelli J.
        • Teno J.M.
        • Miller S.C.
        Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care.
        The Milbank Quarterly. 2004; 82: 227-256https://doi.org/10.1111/j.0887-378X.2004.00309.x
        • National Academies of Sciences
        • Engineering, and Medicine (NASEM)
        The national imperative to improve nursing home quality: honoring our commitment to residents, families, and staff.
        The National Academies Press, Washington, DC2022https://doi.org/10.17226/26526
      11. Office of Inspector General (OIG). 2019. Trends in nursing home complaints: Text-based data. Retrieved February 1, 2022 from https://oig.hhs.gov/oei/maps/2019-nursing-home/text-map.asp

      12. Office of Inspector General (OIG). 2020. States continued to fall short in meeting required timeframes for investigating nursing home complaints: 2016–2018. Washington, DC: Office of the Inspector General, U.S. Department of Health and Human Services.

        • Plunger P.
        • Eitenberger M.
        • Kletecka-Pulker M.
        • Wochele-Thoma T.
        • Klager E.
        • Ruf A.K.
        • Eibensteiner F.
        Using telemedicine in nursing homes during the COVID-19 pandemic: A multi-perspective view on the implementation process.
        Nursing open. 2022; 9: 1155-1163https://doi.org/10.1002/nop2.1155
        • Popejoy L.
        • Vogelsmeier A.
        • Boren W.
        • Martin N.
        • Kist S.
        • Canada K.
        • Rantz M.
        A coordinated response to the COVID-19 pandemic in Missouri nursing homes.
        Journal of Nursing Care Quality. 2020; 35: 287-292https://doi.org/10.1097/NCQ.0000000000000504
        • Rantz M.J.
        • Cheshire D.
        • Flesner M.
        • Petroski G.F.
        • Hicks L.
        • Alexander G.
        • Thomas S.
        Helping nursing homes “at risk” for quality problems: A statewide evaluation.
        Geriatric Nursing. 2009; 30: 238-249https://doi.org/10.1016/j.gerinurse.2008.09.003
        • Rantz M.J.
        • Skubic M.
        • Alexander G.L.
        • Popescu M.
        • Aud M.A.
        • Wakefield B.
        • Miller S.
        Developing a comprehensive electronic health record to enhance nursing care coordination, use of technology, and research.
        Journal of Gerontological Nursing. 2010; 36: 13-17https://doi.org/10.3928/00989134-20091204-02
        • Rantz M.J.
        • Vogelsmeier A.
        • Manion P.
        • Minner D.
        • Markway B.
        • Conn V.
        • Mehr D.R.
        Statewide strategy to improve quality of care in nursing facilities.
        The Gerontologist. 2003; 43: 248-258https://doi.org/10.1093/geront/43.2.248
        • Travers J.L.
        • Agarwal M.
        • Estrada L.V.
        • Dick A.W.
        • Gracner T.
        • Wu B.
        • Stone P.W.
        Assessment of coronavirus disease 2019 infection and mortality rates among nursing homes with different proportions of Black residents.
        Journal of the American Medical Directors Association. 2021; 22: 893-898
        • Travers J.L.
        • Caceres B.A.
        • Vlahov D.
        • Zaidi H.
        • Dill J.
        • Stone R.
        • Stone P.
        Federalrequirements for nursing homes to include certified nursing assistants in resident care planning and interdisciplinary teams: A policy analysis.
        Nursing Outlook. 2021; 69: 617-625https://doi.org/10.1016/j.outlook.2021.01.004
        • Travers J.L.
        • Teitelman A.M.
        • Jenkins K.A.
        • Castle N.G.
        Exploring social-based discrimination among nursing home certified nursing assistants.
        Nursing Inquiry. 2020; 27: e12315https://doi.org/10.1111/nin.12315
        • You K.
        • Li Y.
        • Intrator O.
        • Stevenson D.
        • Hirth R.
        • Grabowski D.
        • Banaszak-Holl J.
        Do nursing home chain size and proprietary status affect experiences with care?.
        Medical Care. 2016; 54: 229-234https://doi.org/10.1097/MLR.0000000000000479