The federal government on Monday announced substantial changes to the government’s five-star rating program for nursing homes, a widely used consumer tool that has been criticized for its reliance on self-reported, unverified data. The five-star rating system has become the gold standard for evaluating the nation’s more than 15,000 nursing homes since it was put in place five years ago, even though two of the major criteria used to rate the facilities — staffing levels and quality statistics — are reported by the nursing homes themselves and generally are not audited by the federal government. On Monday, officials said they would make several changes, starting in January, aimed at addressing some of these concerns. Medicare Star Ratings Allow Nursing Homes to Game the System AUG. 24, 2014 Nursing homes will have to begin reporting their staffing levels quarterly using an electronic system that can be verified with payroll data. And officials will initiate a nationwide auditing program aimed at checking whether the so-called quality measures rating — which is based on information collected about every patient — is accurate. Beginning in January, nursing homes’ ratings will also be based partly on the percentage of its residents being given antipsychotic drugs. In August, The New York Times reported that the rating system relied so heavily on unverified and incomplete information that even homes with a documented history of quality problems were earning top ratings. The number of homes with above-average ratings has increased significantly since the program began: In 2009, 37 percent of homes received four- or five-star ratings. By 2013, nearly half did. Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, which oversees the rating system, said she hoped that higher-quality reporting would lead to better health outcomes for patients. “We are focused on using as many tools as are available to promote quality improvement and better outcomes for Medicare beneficiaries,” she said. Greg Crist, a spokesman for the American Health Care Association, the lobbying group that represents for-profit nursing homes, said many of the changes would capture data reflecting quality improvements that the industry had already been working on. “We’ve seen the improvements in quality across the board,” he said. “Some questioned that a few weeks ago. Yet this push for greater accuracy should help reassure patients and families those improvements are both real and making a difference in improving lives.” Although the federal health care law, passed in 2010, required that nursing homes’ staffing data be collected electronically, the provision was never adopted. Instead, nursing homes reported their staffing levels on a form during their annual inspection, which was rarely audited. On Monday, President Obama signed into law a bipartisan bill passed in September that provides $11 million in funding to set up an electronic collection system. The bill, the Improving Medicare Post-Acute Care Transformation Act, or the Impact act for short, also requires more frequent inspections of hospice facilities. Hospices must now be inspected at least once every three years. Previously, there was no such requirement, meaning many facilities went years without any inspections. The law also allows Medicare to review hospice programs in which a large proportion of patients receive care for six months or more, which is considered a long hospice stay. The changes come as the number of...
read moreNew data shows nursing home workers suffer more injuries than construction, factory and mine workers Posted by Celeste Monforton, DrPH, MPH of George Washington University School of Public Health & Health Services on October 24, 2011 (6) We’ve seen reality shows featuring dirty jobs, cops and coal miners. I wonder if it’s time for one showing a day-in-the-life of nursing home workers. Most of us don’t give much thought to what goes on inside of nursing homes, that is until a friend or family member needs to reside in one. What might appear as a quiet, slow-paced, restful setting is usually a stress-filled, physically-demanding environment for the people who work in them. Lifting and moving patients from beds, toilets, recliners, showers, and wheelchairs can cause all sorts of injuries, but then throw on top of that, the body fluids and infectious agents, staffing shortages, and violent patients and family members. On second thought, it’s probably not a tv show that would attract many viewers. More than 3 million people are employed in US nursing and residential care facilities, where the average wage for non-supervisory employees is about $14 per hour. According to the latest survey by the US Bureau of Labor Statistics (BLS) of work-related injuries and illnesses, the injury-incident rate in 2010 for workers employed in nursing homes was 8.6 per 100 full-time employees (FTEs), more than twice the rate for all private sector workers. When people think of dangerous jobs, I’m sure many think of coal miners or construction workers—not nursing aides at nursing homes. The overall injury-incident rate of 8.6 per 100 FTEs for nursing home employees compares, for example, to rates of 5.6 for workers in underground coal mines, 4.8 for workers in tire manufacturing, and 3.5 for building construction. The situation is no better when you look at the incidence rates for more serious injuries, specifically those that result in days away from work, restricted-duty or transfer to a different job (DART rate). The lost-time/ restricted duty injury case rate for nursing home workers is 5.6 per 100 FTEs, compared to 3.7, 3.3 and 1.7 for these same sub-industries, respectively. For the industries as a whole, the DART rate in the entire construction sector is 2.1 per 100 FTEs, and 2.4 in both manufacturing and health care and social assistance. Although the rates in these industries is comparable, federal OSHA conducts very few inspections in the health care and social assistance industry. In 2010, 11.4 million workers were employed in manufacturing jobs and another 5.7 million in construction jobs. OSHA conducted nearly 78 percent of its inspections at workplaces in these industries. In contrast, the health care and social assistance industry employed more than 16 million U.S. workers. Federal OSHA conducted less than 2 percent of its inspections in these workplaces. The injury rates for nursing home employees, which are predominantly women, are stratified in the BLS data by those facilities operated by state and local governments, and those controlled by private employers. Either way, and no matter whether one is interested in all injuries, or just those resulting in days away from work, restricted duty, or job transfer (DART rates) nursing home workers top the list for the highest rates. In the news release announcing the BLS data, Labor Secretary Hilda Solis said,...
read moreStaffing and Worker Injury in Nursing Homes Alison M. Trinkoff, ScD, Meg Johantgen, PhD, Carles Muntaner, MD, PhD, and Rong Le, MS Author information ► Article notes ► Copyright and License information ► Objectives. We examined the relationship between nursing home staffing levels and worker injury rates in 445 nursing homes in 3 states. Methods. We obtained First Reports of Injury and workers’ compensation data from 3 states (Ohio, West Virginia, and Maryland) for the year 2000. We then linked these data to Medicare’s Online Survey, Certification and Reporting system to obtain nursing home staffing details and organizational descriptors. We used ordinary least squares and log-transformed regression models to examine the association between worker injury rate and nursing home staffing and organizational characteristics. Results. Total nursing hours per resident day were significantly associated with worker injury rates in nursing homes after we adjusted for organizational characteristics and state dummy variables (P=.0004). Conclusions. Our findings suggest that nursing home staffing levels have an important impact on worker health. These findings were supported for multiple facilities across different states; therefore, policies and resources that increase staffing levels in nursing homes are warranted. The health care industry is one of the most dangerous industries, ranking with construction, trucking, and meatpacking in nonfatal injury rates.1 Because of the growing elderly population, nursing homes have become major care providers to the elderly within the health care industry.2 About 1.5 million elderly and disabled Americans reside in nursing homes, and nursing assistants provide the majority of their care.3 second among all industries.4 Nursing homes are among the top 10 industries for musculoskeletal problems, which is the major cause of worker absenteeism, workers’ compensation claims, and worker injury and illness.1,4–7 Higher rates of musculoskeletal injury have been reported among nursing home workers compared with rates among workers in other occupations.8,9 Nursing home employees working in direct-care facilities perform many physically taxing activities, such as lifting heavy loads, working in awkward postures, and transferring residents.6,10–14 Additionally, manipulating the technology that supports patient care is physically straining. The increased worker injury rates likely result from increased exposure to hazardous conditions and diminished recovery time between exposures.15 Worker injuries in health care institutions associated with staffing levels and skill mix have been previously examined. Because health care institutions have been required to perform more efficiently, the resultant changes are lower staffing levels and higher patient loads, both of which have been shown to increase worker injury. In a study of 12 hospitals in the Minneapolis–St Paul, Minnesota, area that used data from 1990 to 1994, Shogren and Calkins16 found that when registered nurse (RN) positions were decreased by 9%, work-related illnesses and injuries among nurses increased by 65%. A review of the impact of staffing on health care by the Institute of Medicine noted that there is empirical evidence that shows back injuries among nurses are associated with staffing levels.17 Although the extent of worker injuries among resident care staff in nursing homes has been documented,18–20 there have been few studies about the association between injuries and staffing. The occurrence of these injuries has important implications for staff retention. Owen and Garg21 found that 20% of nurses who reported they had back pain said they had made at least 1 job change in order to decrease the number of...
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