There is a terrific story that nobody is telling. Homes are getting dramatically better at providing quality care.
News outlets are reporting on anecdotal stories of terrible care that imply just the opposite is happening. A sensational story of a horrible failure in care is more newsworthy than the thousands acts of kindness and love that occur every day in the 15,000 nursing homes across the country. As it should, the press reported on the tragic failure of a nursing home in Florida to evacuate its residents during Hurricane Irma in 2017. Unfortunately, lost in the story were the scores of nursing homes that safely evacuated or transferred residents or sheltered them in place during Hurricanes Irma and Harvey. Lost in the story were the hundreds of stories of certified nurse aides who ignored their own losses and homes to stay at work in nursing homes, working multiple shifts to protect and care for residents.
This negative focus is rampant. A study released last summer revealed that over a 10-year period, 87% of news articles about nursing homes were negative or neutral and only 13% were positive. This leaves the impression that the majority of nursing homes are doing a horrible job taking care of our residents, when in fact the opposite is true.
The facts make it clear that nursing home care has improved significantly. The Center for Medicare & Medicaid Services calculates 24 clinical outcomes for all nursing homes. The CMS measures look at health outcomes, tracking important measures like the percentage of people readmitted to hospitals and the number of pressure ulcers and falls. Of those 24 key outcomes, nursing homes have improved on 20 in recent years.
This didn’t happen by accident. It happened because our profession led the way. Seven years ago, we proposed the AHCA Quality Initiative to CMS and doubled down on our Baldrige-based Quality Achievement program. Our Quality Initiative focused on four goals that set specific improvement targets and deadlines. CMS agreed with our goals, and the work began. Since then, nursing homes have reduced the rate of people returning to the hospital by 30%. We’ve reduced the use of antipsychotic drugs by more than 37%. We now have more applications to our Baldrige-based program than all the state and national Baldrige programs combined. An independent evaluation of the program by academic professors at University of Pittsburgh and University of Wisconsin found recipients of AHCA/NCAL Quality Awards improved significantly more than nursing homes that did not adopt the Baldrige Framework. We’ve accomplished something very difficult to do in public health. We’ve improved care across the entire country in the majority of nursing homes, not just a handful here and there.
Not only have the nursing homes and staff received no credit, we continue to be a political punching bag. Most recently Congress held hearings on nursing home quality. The centerpiece of the hearing was a six-year-old study by the Office of the Inspector General, that was based on data that was even older. Data collected since that study demonstrate significant improvement.
When we make mistakes, we deserve to be scrutinized. That should happen. The care of the frail, elderly and disabled is so important that we should be called out when we fail. But, when we are constantly called out, despite our progress, it masks an important story. Nursing homes are getting better and are committed to continuing this quality improvement.
Mark Parkinson is president and CEO of the American Health Care Association/National Center for Assisted Living.
