Some Improvements in Nursing Home Quality Evident After Beginning of National Initiative

In the period since the Bush administration introduced a quality initiative for nursing homes in 2002, fewer nursing home residents have experienced untreated pain or have been placed in restraints, but the initiative has had "no significant impact" in other areas, such as the occurrence of pressure sores or residents' ability to walk, feed themselves or use the bathroom without assistance, according to a Boston Globe analysis. The scores for the nation's 16,500 nursing homes, which are updated every three months, show what percentage of a facility's residents have any of 15 preventable problems. The initiative will cost $120 million in its first three years, and the government also is paying consultants to teach some homes how to reduce pain and pressure sores. The Globe analysis focused on eight categories for which data were available from 2002 and 2004. According to the Globe's analysis, the reporting of quality scores -- "designed to marshal public pressure to spur change" -- has not generally resulted in marked quality improvements. Many facilities "improved in one aspect of care, only to decline in another," the Globe reports. Some analysts question whether the quality scores accurately reflect changes being made at nursing homes, saying that the scores show how sick residents are instead of the quality of care they receive. The government says it adjusts ratings to reflect patient mix. Additionally, the Globe analysis found no correlation between the quality scores and the results of federal inspections of the homes. Dr. David Gifford, who directs the consultants working with the nursing homes, said that while quality measures are verified by nursing home visits, they are constantly being revised. The Globe also reports that "public pressure is supposed to be a major impetus for improvement on the scores, [but] it is not clear that the public is using the information widely to choose nursing homes."

Reaction
Alice Hedt, executive director for the National Citizens' Coalition for Nursing Home Reform, said advocates are concerned that the worst nursing homes are not included because the program is voluntary, adding that widespread improvement is only possible through better training and staff. CMS Administrator Mark McClellan said, "We've made a tremendous amount of progress, and we've got a lot of work left to do. There are still a number of institutions that have chronic problems." However, another federal official -- who CMS made available to the Globe for an interview on the condition that his name not be used -- said that the government is disappointed that the quality initiative has not resulted in greater, more widespread national gains (Dembner/Dedman, Boston Globe, 12/13).

Globe Looks at Lack of Enforcement at Poor-Quality Institutions
The Globe on Monday also examined "poor-quality homes" that continue "to operate by temporarily fixing the worst problems, only to have them recur a few months later." A federal pilot program was launched in 1999 to send investigators to "troubled homes," but since then some "homes have gotten worse," the Globe reports. While state and federal officials maintain the worst homes have been closed, "inspectors nationwide last year identified 1,464 cases in which nursing homes put the lives of residents in jeopardy and 8,000 more in which they harmed residents," according to the Globe. Of these facilities, two were closed. Additionally, the Globe notes that "despite an increasing number of investigations nationally, citations against nursing homes for harming residents have dropped 42% since 2000, and sanctions of homes have dropped 22%," according to federal reports. Government officials said they are investigating "why enforcement seems to be lagging" and might make changes in enforcement rules by October, the Globe reports. Options for reform include quicker inspections or financial incentives to raise quality (Dembner, Boston Globe, 12/13).