article:Bush Administration seeks expansion program

Shell5 · Jan 7, 2005

US to push for better nursing home care

Bush administration seeks expansion of 2-year-old program

By Alice Dembner, Globe Staff | December 23, 2004

The Bush administration plans to expand a two-year-old initiative to improve nursing home quality that has so far had mixed results, officials announced yesterday. They said they will try to tackle some underlying problems with the way nursing homes are staffed and managed, including staff turnover, hiring of workers with criminal backgrounds, and the hospital-like environment in some homes.

At a news conference, Health and Human Services Secretary Tommy Thompson said "nursing home residents have better care," but acknowledged that "much more can be done." A Globe analysis published Dec. 13 found that the initiative reduced the portion of residents nationally who suffer from untreated pain and are placed in restraints, but had no significant impact on the portion with pressure sores or other problems.

Faced with the persistence of poor-quality homes, the government has invested $120 million over three years in an initiative designed to boost quality by publicly grading nursing homes on the proportion of residents who have preventable problems and by providing some guidance from quality consultants.

Yesterday, the administration released new numbers showing that on average, the 2,400 homes nationwide that volunteered to work with government-paid consultants started out slightly worse and improved more than others, although the overall trends were the same. For example, at homes that got help, the percentage of residents with chronic pain fell from 12 to 6, while at other homes it fell from 10 percent to 7 percent.

In announcing the results, Thompson pointed to a West Roxbury home, the German Centre for Extended Care, as a success story. The home reduced the percentage of residents with chronic pain from 25 to 1, and those with pressure sores from 11 percent to 5 percent. But it also saw a slight drop in the percentage of residents who could feed themselves or use the bathroom on their own.

Thompson said the administration plans an aggressive effort to improve more homes. The government will pay consultants to help homes develop care built around residents' schedules and desires, and to increase staff satisfaction and autonomy.

In addition, it will begun a tougher program of background checks for direct-care workers in seven states. And it will focus more attention on reducing pressure sores, restraints, and depression.

But the quality improvement program remains voluntary, and the government plans to provide help to only a fraction of the 16,500 homes nationwide. While praising the results so far, consumer advocates said the government needs to expand its effort while also focusing on those with the poorest quality.

"The facilities that have volunteered tend to be the facilities that are eager to improve," said Alice Hedt, executive director of the National Citizens Coalition for Nursing Home Reform. "We would like to see . . . more effort on facilities that are not providing good care."

Officials of the two national nursing home trade associations said they are committed to improving on their own. But they said that homes also need higher reimbursements for Medicare and Medicaid patients and the incentive of funding tied to good performance -- a concept Thompson said is being explored.

"We must be sure we reward quality care to ensure that in the future there will be only two kind of nursing homes -- the excellent and the nonexistent," said Barbara Manard, vice president of the American Association of Homes and Services for the Aging.

**At least where I'm at, any improvement is better than

none. I welcome this idea. What do you think?