Assessing, improving, and implementing quality nursing home resident care is an ongoing effort for many professionals in the industry. Nursing home administrators have worked hard to improve the quality of care provided to residents and to improve neglectful reputations earned by nursing homes in previous decades. Current nursing home standards and management practices prioritize resident satisfaction.
Considerations in Nursing Home Resident Care
Data collected within the last decade estimates that approximately 1.6 million elderly and disabled persons receive care in nursing homes. By fostering a community of communication among staff, families, and residents, nursing home managers are able to minimize patient suffering through proper medication administration and frequent intervention.
Managing Nursing Homes
Nursing home managers need to be knowledgeable about their residents’ medical conditions and be capable of providing quality care. Having a robust knowledge of medical terminology, physiology, and gerontology helps managers make appropriate, potentially life-saving decisions about their residents.
In addition to addressing resident-specific needs, managers also serve as state-licensed facility overseers. They coordinate staff; develop, implement, and enforce policies; and handle medical records. They also manage the finances, bills, and budgets associated with running a nursing home. The professional preparation for a career in nursing home management involves earning either a Bachelor’s or Master’s degree in or specializing in Healthcare Administration and Management. Managers need to be well-versed in the administrative and personal aspects of running a nursing home.
Resident Treatment & Care
There are many steps that managers can take to ensure resident care is of top quality. Administratively, managers should:
- Conduct employee screenings prior to hiring
- Train staff on proper care and attitude when dealing with resident needs and ailments. Policies, procedures and federal guidelines for nursing home operation will ensure quality care for patients
- Publish and make transparent nursing home operational policies and emergency plans (fire, burglary, natural disaster, patient medical emergency, etc.)
- Ensure the nursing home is updated and maintained with the necessary technologies and facilities such as lighting, security, cleanliness, furniture etc.
- Ensure patient access to a healthcare official
Patient care also requires managers to approach their role from a humanistic standpoint. Many nursing home residents are of an advanced age. They may be suffering from medical problems that impair their mobility or cognitive functions. Further, some patients might be lonely having little family or few friends in the area. Managers should be compassionate, putting residents’ needs above other priorities. Other considerations for patient care should include:
- Giving residents choices about their daily routines; if possible, let patients determine when they wake up and go to bed, eat, bathe, exercise, etc.
- Providing updated, attractive common areas such as the dining room, game room or outdoor living spaces
- Keeping a full staff at all times, so patients in need do not have to wait or look for someone to assist them
- Facilitating good communication between residents, families, or staff will minimize stress to residents and ensure smoother operations
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Nursing Home Quality Assessment
It has been half a century since the U.S. Department of Health, Education, and Welfare under Public Health Services began assessing nursing home licensing. Investigation resulted in the production of the Nursing Home Standards Guide, which recommended standardization for what constituted a nursing home’s care-personnel terminology, and minimum health and safety standards.
The (then new) Medicare and Medicaid programs influenced the rise in nursing home popularity. Given the supply / demand conundrum, quality issues were prevalent in much of the late 1960s and early 1970s. By the late 70s, the Health Care Financing Administration (HCFA) was created and began a certification process for the ever-amounting nursing home standards.
Other advances toward improving standards stemmed from the Nursing Home Reform Act and the Resident Assessment Instrument. By the mid-to-late 1990s, quality measures to assess resident health were implemented; structural, process, and outcome quality became indicators by which to measure nursing homes.
At the turn of the millennium, the Centers for Medicare & Medicaid Services (CMS) implemented the Special Focus Facility (SFF) program, which is still in use to assess poorly performing nursing homes and monitors improvements. The SFF notifies states and relevant authorities of SFF-designated nursing homes, publishes names of SFF homes on the CMS website, and intervenes at stagnant nursing homes.
Modern Resident Quality Assessment
Quality measures currently in use are based on previously collected data and studies. The purpose of nursing home quality assessment is to provide information:
- For residents to be able to decide if the facility is appropriate for their needs.
- Nursing home managers can assess where improvement efforts need to be directed.
The CMS provides a five-star quality rating system that rates nursing homes on health inspection results, staffing quality or quantity, and clinical quality measures (QMs). QMs assessment is based on the quantity of residents:
- Needing help with daily living activities
- Requiring help installing a catheter
- Needing physical restraint to protect patient and others
- Self-reporting moderate to severe pain
- Experiencing falls and injuries
- Being diagnosed with urinary tract infections
- Showing new or worsening pressure ulcers
- Experiencing significant weight loss
- Who were assessed and given the Influenza and/or Pneumococcal Vaccine as appropriate
The information provided by quality assessment enables nursing home managers to develop plans that address lowering costs, improving individual care and enhancing health for the overall resident population.
Implementing Resident Care Performance Improvement
In addition to the results of quality assessment, nursing home managers should use other research and resources for enriching the standard of resident treatment. For example, following the passing of the Affordable Care Act, the CMS developed a Quality Assurance and Performance Improvement Program (QAPI) in 2011. The data and resources provided by the QAPI were made available in August 2012, and the information continues to be used to improve procedures and issuing resident care guidance.
Some implementations toward improving resident care pertain to:
- Care transitions: Hospital readmission for residents transitioning from hospitals to nursing homes is extremely costly. Nursing homes are undergoing assessment to aid in preventing such incidents.
- Fall risks: Fall risks in nursing homes are high and can lead to serious injury. Fear of falling can also result in nursing home residents minimizing mobility, which can result in negative health risks. Aside from guaranteeing facilities are safe, studies indicate that falls can be prevented by ensuring medications, which can cause dizziness.
- Avoiding hospitalizations: Interventions to avoid hospitalization and improve resident health, require nursing homes to hire staff who partner with nursing facilities and provide preventative services.
There are other practices managers can undertake to improve resident care. Finding ways to reduce staff turnover, increasing family and staff satisfaction, and developing advanced care plans can indirectly improve resident care. Providing quality care to nursing home residents is a rewarding venture for any healthcare administrator possessing the requisite training and skills.
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