Nursing Homes: The Basics Sarah Greene Burger, RN-C, MPH, FAAN Ethel Mitty, EdD, RN Mathy Mezey, EdD, RN, FAAN Hartford Institute for Geriatric Nursing, New York University College of Nursing Module 1 of Nursing Homes as Clinical Placement Sites for Nursing Students Series
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Nursing Homes: The Basics
Sarah Greene Burger, RN-C, MPH, FAANEthel Mitty, EdD, RN
Mathy Mezey, EdD, RN, FAAN
Hartford Institute for Geriatric Nursing, New York University College of Nursing
Module 1 of Nursing Homes as Clinical Placement Sites for Nursing Students Series
Dementia SCUs are the most common type (22%) (Originally for residents with mild/moderate stage dementia)
Sub-acute Care Units provide short-term intensive rehab and continuous medical monitoring
Types of Sub-acute Care Units include ventilator dependent, traumatic brain injury, oncology, pressure ulcer care, AIDS, skilled rehab, palliative care and hospice units
Nursing Home Regulations: The Nursing Home Reform Act 1987 (NHRA [OBRA’87]) (PL 100-203)
Most federal regulation of Nursing Homes stems from The Nursing Home Reform Act 1987. Components of the Act include the following: Nursing homes are certified as a Medicare and/or Medicaid skilled
nursing facility by the federal government (Centers for Medicare and Medicaid [CMS]).
“Conditions of Participation”: Spells out the mandates that a nursing home is obliged to meet in order to remain Medicare/Medicaid certified and eligible for reimbursement
Specifies that people living in a nursing home are “residents” – not patients.
Requires that every facility is “to care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of quality of life of each resident” and to “provide services and activities to attain or maintain, for each resident, the highest, practicable physical, mental and psychological well-being.”
CMS Mandate for Interdisciplinary Team in Medicare and Medicaid NHs
Physicians are the legal head of the team and the team includes nursing, social worker, activities therapist, nutritionist, rehabilitation, and others (e.g. psych) on ad hoc basis
CNAs can (and should) be a member of the interdisciplinary team
Resident, family, health proxy/surrogate, if resident wishes, are also part of the team
The CMS 5 Star Quality Rating System is a nationally recognized
standard against which to assess nursing homes.
Star rating reflects a Nursing Home’s quality status for the past
12-15 month period.
Higher star ratings reflect better quality: 5 Stars: top 10% of nursing homes within the state 2, 3, 4 Stars: middle 70% of nursing homes within the state 1 Star: bottom 20% of nursing homes within the state
Quality Domain of the CMS 5 Star Quality Rating System
Assessment of Quality based on data in the Minimum Data Set
Quality Measures (QMs) are issued by the NHQI Quality Initiative*
All QMs are validated, reliable and endorsed by the quality measure rating agency: National Quality Forum
The Quality Domain,
consists of the following
characteristics:
For comparison of quality measures across homes go to www.medicare.gov/NHCompare
Quality Measures (QMs) are believed to be within the NHs ability to influence and control
Seven Long-stay QMs: The percent of residents (1) whose need for ADL assistance increased; (2) whose in-room mobility decreased; (3) are “high-risk” and have pressure ulcers; (4) have an indwelling urinary catheter; (5) are physically restrained; (6) have a UTI; (7) have moderate to severe pain.Four Short-stay QMs: The percent of residents with (1) pressure ulcers; (2) delirium; (3) moderate to severe pain.
Resource Utilization Groups III (RUGs) is a method of assigning payment for care in NHs (achieving a similar aim as DRGs in hospitals)
It is a case-mixed reimbursement system in which ADL data is essential. It also reflects the amount of resources (human and other) needed to provide care