Improving the Quality of Care in Nursing Homes (1986) / Chapter Skim
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8. Actions Required and Cost Implications of the Recommendations
8. Actions Required and Cost Implications of the Recommendations
Pages 203-212
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From page 203... ...
promulgating new survey anti certification regulations and major revisions of existing regulations, (3) designing and testing a standard procedure for resident assessment to be done by nursing home staff and then developing training materials and launching a major program to train all RNs and LPNs (LVNs)
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From page 204... ...
These recommendations involve major revisions in the language and structure of the existing regulations, including promulgating new conditions of participation covering quality of life, quality of care, resident assessment, residents' rights, and administration. The following current conditions would be reclassified as standards under the administration condition: governing body and management, utilization review, transfer agreements, disaster preparedness, medical direction, laboratory and radiological services, and medical records.
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From page 205... ...
The HCFA should increase the federal share of funding of state survey and certification activities from 75 percent to 100 percent. Between 1965 and 1972, Title XIX authorized federal funding of 75 percent of the states' costs of surveyor salaries, travel, and training for survey and certification of Medicaid facilities.
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From page 206... ...
Amendments to the Older Americans Act The following recommendation will require amendments to the Older Americans Act: Recommendation 6-2. The ombudsman program should be strengthened by the following statutory actions: i · authorizing the ombudsman program as a separate title n the Older Americans Act; · authorizing federal-state matching formula grants for the ombudsman program; · authorizing a statutory national advisory council; · authorizing access to nursing homes and to residents' records (with the residents' permission)
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From page 207... ...
The survey procedures depend on access to standard resident assessment data, so that high priority should be given to developing the resident assessment data set, the procedures for collecting it, recording the data, prescribing standard case-mix definitions for survey purposes, specifying sampling procedures, and developing training programs and materials for nursing home staff who will be required to conduct resident assessments. DESIGN AND TESTING ACTIVITIES Resident Assessment Data Design, testing, and installation of a standard facility-administered resident assessment system is a large and complex undertaking.
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From page 208... ...
The groupings will be needed for survey sampling purposes. The initial groupings are likely to be based on limited data and will need to be revised as empirical evidence from longitudinal assessment data become available and analysis reveals that alternate
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From page 209... ...
Statistically sound sampling is essential to establish both public and provider confidence in the validity of a somewhat abbreviated standard survey process. Once this manual system for resident assessment data has been introduced and implemented in nursing homes, the steps needed to gain ready access to the data for regulatory purposes should be studied.
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From page 210... ...
The quantitative and qualitative changes in behavior of the various actors in the system, and the effects on efficiency of the regulatory agencies and nursing homes, cannot be predicted on the basis of current data; (2) current data about staffing and costs in nursing homes and in state regulatory agencies are not available in sufficient detail; and (3)
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From page 211... ...
However, the new system will require well-qualified and well-trained survey staff and this may, in some states, require larger survey agency budgets. How much larger will depend on the performance of the nursing homes.
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From page 212... ...
The good nursing homes have been conducting very comprehensive assessments of their residents as part of their normal resident care activities. The federal requirement to do so in a standard way should not add significantly to resident care costs.
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