This Viewpoint discusses the long-standing deficiencies in nursing home financing and organization made worse by the spread of coronavirus disease 2019 (COVID-19), and proposes ways to improve ...testing and personal protective equipment availability, and payment reforms to incentivize quality care for residents and decrease emergency department and hospital use.
The pandemic of viral infection with the severe acute respiratory syndrome coronavirus‐2 that causes COVID‐19 disease has put the nursing home industry in crisis. The combination of a vulnerable ...population that manifests nonspecific and atypical presentations of COVID‐19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID‐19 among nursing home residents have created a “perfect storm” in our countryʼs nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal. J Am Geriatr Soc 68:2153–2162, 2020.
This Special Article comments on the article by White et al. in this issue.
Nursing staff turnover has long been considered an important indicator of nursing home quality. However, turnover has never been reported on the Nursing Home Compare website, likely because of the ...lack of adequate data. On July 1, 2016, the Centers for Medicare and Medicaid Services began collecting auditable payroll-based daily staffing data for US nursing homes. We used 492 million nurse shifts from these data to calculate a novel turnover metric representing the percentage of hours of nursing staff care that turned over annually at each of 15,645 facilities. Mean and median annual turnover rates for total nursing staff were roughly 128 percent and 94 percent, respectively. Turnover rates were correlated with facility location, for-profit status, chain ownership, Medicaid patient census, and star ratings. Disseminating facilities' nursing staff turnover rates on Nursing Home Compare could provide important quality information for policy makers, payers, and consumers, and it may incentivize efforts to reduce turnover.
The coronavirus disease 2019 (COVID-19) pandemic continues to devastate US nursing homes. Adequate personal protective equipment (PPE) and staffing levels are critical to protect nursing home ...residents and staff. Despite the importance of these basic measures, few national data are available concerning the state of nursing homes with respect to these resources. This article presents results from a new national database containing data from 98 percent of US nursing homes. We find that more than one in five nursing homes reports a severe shortage of PPE and any shortage of staff. Rates of both staff and PPE shortages did not meaningfully improve from May to July 2020. Facilities with COVID-19 cases among residents and staff, as well as those serving more Medicaid recipients and those with lower quality scores, were more likely to report shortages. Policies aimed at providing resources to obtain additional direct care staff and PPE for these vulnerable nursing homes, particularly in areas with rising community COVID-19 case rates, are needed to reduce the national COVID-19 death toll.
People who are dually enrolled in Medicare and Medicaid face issues related to fragmented care and poor health outcomes associated with inadequate coordination of benefits and services.
BACKGROUND/OBJECTIVES
The 2019 coronavirus disease (COVID‐19) has been documented in a large share of nursing homes throughout the United States, leading to high rates of mortality for residents. To ...understand how to prevent and mitigate future outbreaks, it is imperative that we understand which nursing homes are more likely to experience COVID‐19 cases. Our aim was to examine the characteristics of nursing homes with documented COVID‐19 cases in the 30 states reporting the individual facilities affected.
DESIGN
We constructed a database of nursing homes with verified COVID‐19 cases as of May 11, 2020, via correspondence with and publicly available reports from state departments of health. We linked this information to nursing home characteristics and used regression analysis to examine the association between these characteristics and the likelihood of having a documented COVID‐19 case.
SETTING
All nursing homes from 30 states that reported COVID‐19 cases at the facility‐level.
PARTICIPANTS
Nursing home residents in states reporting data.
MEASUREMENTS
Whether a nursing home had a reported COVID‐19 case (yes/no), and conditional on having a case, the number of cases at a nursing home.
RESULTS
Of 9,395 nursing homes in our sample, 2,949 (31.4%) had a documented COVID‐19 case. Larger facility size, urban location, greater percentage of African American residents, non‐chain status, and state were significantly (P < .05) related to the increased probability of having a COVID‐19 case. Five‐star rating, prior infection violation, Medicaid dependency, and ownership were not significantly related.
CONCLUSION
COVID‐19 cases in nursing homes are related to facility location and size and not traditional quality metrics such as star rating and prior infection control citations. J Am Geriatr Soc 68:1653‐1656, 2020.
Staffing is an important quality measure that is included on the federal Nursing Home Compare website. New payroll-based data reveal large daily staffing fluctuations, low weekend staffing, and daily ...staffing levels often below the expectations of the Centers for Medicare and Medicaid Services (CMS). These data provide a more accurate and complete staffing picture for CMS and consumers.Staffing is an important quality measure used to profile nursing homes on the federal Nursing Home Compare website. Since staffing data were first reported on the website in 1998, Nursing Home Compare has relied on facility-reported data that describe staffing during the two weeks before each nursing home's annual recertification survey.1 Researchers have questioned the completeness and accuracy of these rarely audited facility-reported staffing data.1-4 In 2016 the Centers for Medicare and Medicaid Services (CMS) introduced the Long-term Care Facility Staffing Payroll-Based Journal (PBJ) system, to which nursing homes are required by Section 6106 of the Affordable Care Act to submit auditable payroll-based staffing and resident census data quarterly.5 With their detailed daily snapshots, PBJ data permit deeper insights into staffing patterns than was previously possible. Importantly, the data suggest that a large proportion of nursing homes often have daily staffing below CMS's case-mix-adjusted expected staffing levels (exhibit 1).Reflecting the potential value of the PBJ data, CMS began using them as the source for staffing information in Nursing Home Compare and the Five-Star Quality Rating System in April 2018. In this article we showcase the more granular PBJ staffing data as a new and valuable resource to expand the evidence base on nursing home staffing by analyzing PBJ and facility-reported staffing levels, staffing at the time of the annual inspection relative to the rest of the year, staffing across different days of the week, facility factors associated with low weekend staffing, observed versus expected staffing based on resident acuity, and compliance with federal nurse staffing standards.
Home- and community-based services can address needs of people with disabilities and older adults. U.S. policymakers can accelerate efforts to transition people from nursing homes to the community.
Guidelines on how the medical community and policy makers should prepare for the second surge of COVID-19 patients on postacute care facilities are suggested. In such a scenario, adequate ...infrastructure, staff training and protective equipment must be ensured for postacute care facilities.
Is every day at home a good day? Ankuda, Claire K.; Grabowski, David C.
Journal of the American Geriatrics Society (JAGS),
September 2022, Letnik:
70, Številka:
9
Journal Article
Recenzirano
Odprti dostop
This Editorial comments on the articles by Freed et al. and Shen et al. in this issue.
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