Nursing Homes, Advocates Join Forces to Improve Quality Care

Article excerpt

Most people dislike and fear nursing homes. They imagine older people strapped into wheelchairs, pocked with pressure wounds and stuck in soggy incontinence pads. They imagine loneliness and abandonment. Certainly, media reports have reinforced this image with such headlines as "Deadly Neglect: The Shocking Truth About What's Going Cm in America's Nursing Homes" (Readers Digest, December 2006) and "Business as Usual: Bad Care Persists, and Good Homes Are Still Hard to Find" (Consumer Reports, September 2006).

QUALITY IMPROVEMENT

However, a new effort is underway to turn this dismal image around with quality improvement campaign by what some have called an "unprecedented" coalition of industry representatives and consumer advocates: The two-year Advancing Excellence in America's Nursing Homes Campaign, launched last September at the National Academy of Sciences auditorium in Washington D.C. Among the campaign's more than 20 participating national organizations are. the Alliance for Quality Nursing Home Care, American Health Care Association, Commonwealth Fund, Centers for Medicare and Medicaid Services and National Citizens' Coalition for Nursing Home Reform (NCCNHR).

"In a nutshell, the campaign is trying to improve quality of life for residents and staff," said Brace Rosenthal, a vice president of the American Association of Homes and Services for the Aging (AAHSA). Speaking to media at the 2007 Joint Conference of the American Society on Aging and National Council on Aging last spring, Rosenthal stated, "We put together what I'd call a dream- team coalition. This campaign led us to identify eight goals: four clinical quality goals and four organizational assessment goals."

The makeover of the nursing home industry began in the 1980s and was propelled by ground-breaking initiatives such as the Pioneer Network, Well Spring, the Eden Alternative and the Nursing Home Reform Act of 1987. In this spirit, the Good Samaritan Society, an eldercare organization, brought together a group of industry leaders who developed several quality initiatives, including the Quality First program, a self-monitoring program sponsored by three nursing homes associations.

At the launch of the new campaign last January, Joe Angelelli of the Pioneer Network praised the cooperative nature of the coalition, observing, "The spirit of the movement of culture change is all about what can we do together that we cannot do separately." What makes the campaign particularly unusual is that it is entirely voluntary, with no paid staff. All participants are donating their time and their staffs' time.

Also, there are no regulatory or reimbursement requirements attached to taking part in the campaign. Nursing homes voluntarily track their progress. Rosenthal emphasized that a goal of the campaign is to move "from an atmosphere of regulatory crime and punishment to continuous quality improvement."

TWO YEARS

The campaign anticipates signing up 6,000 of the approximately 16,000 nursing homes in the United States by the end of 2007, and by July io, 5,535 had joined. Each nursing home accepts responsibility for meeting at least three of the eight goals, such as reducing pressure wounds or the use of physical restraints. To date, homes have agreed to take on an average of four goals they feel they can meet by the campaign's completion in September 2008, when the coalition's analysts will collect and begin crunching the data.

The nursing home industry, Rosenthal said, "must build credibility, we must build trust, we must be transparent. The hope is that the residents, potential residents and family members will go to nursing homes and ask, 'Is your nursing home part of the campaign. And if not, why not? If you are, which three or four goals have you selected, and how are you meeting those goals?'"

Rosenthal continued, "We see the campaign as an opportunity to redefine quality for all stakeholders in nursing homes, to build the public's trust and to acknowledge our moral commitment. …