Approximately 1.5 million Americans live in nursing homes. The quality of life for these residents is often compromised as they face daily difficulties and challenges, one of which is the risk of falling and causing more injury to their aging and frail bodies.
Thankfully, relief can be found through recent research that utilized tunable LED lighting, resulting in a significant 43% reduction in falls based on two years’ worth of data, making it the largest study of its kind with over 126,000 patient-days of data (all pre-COVID).
The study published in The Journal of American Medical Directors Association was designed and administered by Midwest Lighting Institute (MLI) and conducted by Brigham & Women’s Hospital Division of Sleep and Circadian Disorders – a division of Harvard University.
At the heart of the new lighting is an evidence-based protocol using tunable LED lighting that mimics the variation of light level and color that occurs in a natural, 24-hour cycle, as compared to traditional nursing home fluorescent lighting that does not vary throughout the day. This study is based on research findings over the last 15 years on how lighting affects alertness, cognitive function, and sleep.
The MLI project was funded by the Center for Medicare & Medicaid Services’ Civil Money Penalty Reinvestment Program (CMPRP) via the State of Wisconsin Department of Health. Under the program, CMS can issue a Civil Money Penalty, or CMP, which is essentially a fine imposed on long-term care facilities for noncompliance with one or more Medicare and Medicaid requirements. A portion of CMPs collected from nursing homes are returned to states and can be reinvested under the CMPRP to support activities that benefit nursing home residents and protect or improve their quality of care or quality of life.
While this was straightforward in Wisconsin, MLI hit a brick wall in Iowa, where another application for these funds was rejected by CMS. The rationale for rejection was that CMP funding cannot be used for capital improvements, such as lighting systems.
However, the MLI project did exactly what the fund was intended to do, which is “improve quality of life by equipping nursing home staff, administrators and stakeholders with technical tools and assistance to enhance resident care.”
The reduction of falls is a significant improvement that is critical for the life and well-being of residents, given that injuries and hospitalizations from falls can lead to higher morbidity and long-term complications. When compared to other fall-prevention strategies that are typically complex, multicomponent interventions requiring significant resources, staff time and resident education, these lighting systems provide a method for reducing falls that is noninvasive, safe, passive, and relatively inexpensive.
A call to action: Recognizing the value of proper lighting
Given what MLI faced in Iowa, we believe an exception to the capital expenditure provision should be made for these lighting systems for the following reasons:
- The products could not be claimed as depreciable assets because they would be paid for by government funds
- Any uptick in real estate valuation would be relatively small and would not significantly benefit the owner
- Relatively speaking, the overall savings to the government and to the seniors being served in these facilities far outweighs any potential for benefiting the recipient building owner financially
Simply put, the biggest financial benefit from reduced falls goes to CMS – which means we all benefit from this as taxpayers and present and future Medicare and Medicaid beneficiaries. Moreover, since the CMP money is already in place, it costs CMS nothing to support these lighting installations. Instead, using existing CMP funds derived from penalties for non-conformance to support the installation of a system that can enhance the quality of life for the residents is precisely what this fund was meant to accomplish.
If CMP funding cannot be used, then we suggest that CMS fund the installation of these systems. A conservative engineering estimate considering the cost of retrofitting an existing 100-bed facility with a new tunable LED system indicates a 3-year payback to CMS, not accounting for potential added savings that result from reductions in related costs, such as the potential for reduced medications and other long-term savings.
Other savings, such as reduced staff injuries and stress from their involvement with falls, reduced liability to owners (and thus reduced overall costs), and reduced burdens on families should also be considered since these also ultimately affect CMS costs. Given all the positive outcomes from the lighting system, it’s conceivable that CMS would be seeing a net gain from the investment as early as the second year after installation.
As a non-profit entity, MLI’s objectives are to improve the quality of life for all people through improved lighting. Our role in moving this lighting system forward will be to ensure consistency of approach by licensing the patented MLI lighting protocol for a modest fee that will support more research and data gathering to assess other potential benefits. For instance, we have indications that this method can improve mood and cognitive function, and perhaps lowered use of certain medications – but we have not been able to analyze this data due to limited funding.
In my nearly three decades designing lighting systems and studying the effects of lighting, I can say that this research conducted by Brigham & Women’s University may be one of the most impactful on the positive effects light can have on seniors living in nursing homes. It is time that we utilize the Civil Money Penalty funding program to give our seniors a better chance for a better life.
Brian Liebel, PE, is the director of research at the Midwest Lighting Institute (MLI). Prior to joining MLI, Brian was the director of standards and research at the Illuminating Engineering Society and was the principal investigator for the US Department of Energy’s program on Spectrally Enhanced Lighting. He has been involved with research investigating the effects of lighting spectrum on vision for more than 25 years. He can be reached at [email protected].
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
