Improving the Quality of Care in Nursing Homes (1986) / Chapter Skim
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6. Other Factors Affecting Quality of Care and Quality of Life in Nursing Homes
6. Other Factors Affecting Quality of Care and Quality of Life in Nursing Homes
Pages 171-189
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From page 171... ...
Pressures by regulators and consumers certainly can influence management and staff attitudes and behavior, but such pressures are not sufficient to produce the management and staff attitudes and to attract the quality of personnel needed to provide high quality of care and quality of life to nursing home residents. The desire for excellent performance and the ability to create the climate that will attract highly motivated and well-qualified professionals to work in nursing homes must be nurtured by sources within the industry and the educational and professional institutions 171
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From page 172... ...
staff in a long-term-care facility need to obtain systematic feedback on the care needs and desires of individual residents to ensure that their plans of care fit the residents' perceptions -- as well as those of the staff -- of their physical and psychosocial needs. Several recommendations in Chapter 3 address the issue of ensuring resident participation in nursing home decision-making.
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From page 173... ...
render many residents incapable of assertion and self-protection.2 Thus, many nursing home residents are too frail and too vulnerable to effectively influence the attitudes and behavior of nursing home staff in homes that are not very sensitive to residents' needs. Without the assistance of effective consumer advocates, such residents usually cannot communicate complaints to outside agencies that could help them.
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From page 174... ...
These documents should be required to be readily accessible at nominal cost to consumers and consumer advocates, including state and local ombudsmen. The O mbudsman Program The ombudsman program emerged in the early 1970s in response to growing public awareness of the need for stronger consumer protection activities in nursing homes to supplement government regulation.
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From page 175... ...
If the laws and regulations are not being applied to her or to him, they might just as well not have been passed or issued.4 The statutory authority for the ombudsman program dates from 1978 (minor amendments were added in 1984) when the Older Americans Act was amended to require that every state agency on aging include in its multiyear plan of proposed activities assurances that each state plan will (A)
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From page 176... ...
establish a statewide uniform reporting system to collect and analyze data relating to complaints and conditions in long-term care facilities for the purpose of identifying and resolving significant problems, with provision or submission of such data to the agency of the State responsible for licensing or certifying long-term care facilities in the State and to the Commissioner on a regular basis; (D) establish procedures to assure that any files maintained by the ombudsman program shall be disclosed only at the discretion of the ombudsman having authority over the disposition of such files, except that the identity of any complainant or resident of a long-term care facility shall not be disclosed by such ombudsman unless (i)
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From page 177... ...
· The ombudsmen are to be available to help all residents of nursing homes and other long-term-care facilities, not only those funded by Medicare and Medicaid. · The ombudsman program was evidently conceived as a bridge between the state government and the nongovernmental consumer advocacy groups.
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From page 178... ...
Successful programs tend to have the following factors in common: budget continuity, some professional staff, a qualified supervisor, organizational sponsorship but independence in operation, standard methods of intervening and representing residents, consistent documentation of findings and actions, and standard methods of correcting problems and coordinating with regulatory and community services agencies.2~6~9 Ombudsmen help individual residents and their families negotiate with nursing homes and regulatory agencies. They deal with individuals and their orientation is problem-solving rather than regulatory.
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From page 179... ...
Local programs vary widely within and among states in their organizational arrangements and the training and qualifications of ombudsmen. Most ombudsman programs rely heavily upon volunteers to carry out the day-to-day work in nursing homes.
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From page 180... ...
In April 1984 the Office of Management and Budget issued a revision of OMB Circular A-122, "Cost Principles for Non-Profit Organizations." Among other provisions, the circular prohibits federally funded programs from lobbying. The Older Americans Act makes ombudsmen responsible for monitoring legislative and regulatory events to advise public officials on the perceived effects of particular laws and regulations on nursing home residents.
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From page 181... ...
The successful ombudsman programs have demonstrated the considerable value these programs have for nursing home residents, but there are too few successful programs. These circumstances are not likely to change without increased funding and stronger federal direction for the program.
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From page 182... ...
members of the general public to advise on administration, training, program priorities, alevelopment, research, and evaluation; · authorize state-certified substate and local ombudsmen, including trained, unpaid! volunteers, access to nursing homes and, with the permission of the resident, to a resident's medical and social records; · authorize public legal representation for ombudsman programs; · exempt the ombudsman programs, including substate ombudsmen who are supported by funds from the state ombudsman program, front the antilobbying provisions of OMB Circular A-122.
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From page 183... ...
, nursing home residents and their families benefit. A few states have developed formal, written agreements between state regulatory agencies and the state ombudsman program that cover information-sharing, training, and case referral between surveyors and ombudsmen.
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From page 184... ...
Increasing community involvement with nursing homes on a regular, sustained basis is important for three reasons: (1) to enhance the quality of life of nursing home residents by reducing their sense of isolation from the community and providing opportunities for stimulating social interactions, (2)
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From page 185... ...
A number of professional organizations and institutions have contributed to this growth of professionalism. Although the committee does not believe it would be sound public policy to allow JCAH accreditation to serve -- in lieu of a state survey -- as a basis for certifying a nursing home, it does believe that the accreditation process is an important and very desirable way for the industry to raise its own standards of performance using the techniques of peer judgment and consultation.
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From page 186... ...
All states license nursing home administrators, although requirements for state licensure vary widely. Nursing home administrators have formed an active professional association -- the American College of Health Care Administrators -- to raise qualifications and to enhance the professionalism and skills of its members.
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From page 187... ...
Another step toward professionalism is indicated by the large interstate proprietary nursing home chains that have started internal corporate quality assurance programs. For example, the National Health Corporation introduced a computerized resident assessment system about 12 years ago in its eight-state chain of 50 nursing homes.20 The system has multiple purposes, but among them is outcome-oriented quality assurance by means of longitudinal analysis of changes in resident status.
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From page 188... ...
The HCFA and state governments can apply this concept in their dealings with nursing homes. The current federal regulatory system is structured only to punish poor behavior.
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From page 189... ...
Currently, 46 states require nursing homes to obtain certificates of need before expanding services.23 In 25 states, the agency granting a CON first reviews the facility's licensure and certification record. These states use the procedure as a sanction against poor providers, denying certificates of need to providers with records of poor care.
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