Nursing Home Safety: Current Issues and Barriers to Improvement

Gruneir, Andrea; Mor, Vincent

doi:10.1146/annurev.publhealth.29.020907.090912

Cited by 53 publications

(35 citation statements)

References 95 publications

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“…Presence of pressure ulcers is considered to be an important quality indicator in nursing homes since it is closely related to quality of life, mortality, and morbidity (7–9), yet it is potentially preventable (10–12). The occurrence of pressure ulcers among nursing home residents is common (7, 13).…”

Section: Introductionmentioning

confidence: 99%

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Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State

Cai¹,

Mukamel²,

Temkin‐Greener³

2010

Medical Care

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Objective The occurrence of pressure ulcers (PUs) in nursing homes (NHs) is a marker for poor quality of care. We examine whether differences in PU prevalence between Black and White residents are due to within- or across-facility disparities. Methods 2006–2007 Minimum Data Sets are linked with the Online Survey Certification and Reporting (OSCAR) database. Long-term care (LTC) residents with high risk for PUs are identified. The dependent variable is dichotomous, indicating PU presence/absence. Individual race and facility race-mix are the main variables of interests. The sample includes 59,740 LTC high-risk residents (17.4% black & 82.6% white) in 619 NHs. We fit three risk-adjusted logit models: base, conditional fixed-effects, and random-effects. Results Unadjusted PU prevalence is 14.5% (18.2% for Blacks and 13.8% for Whites). Overall, Blacks are more likely to have PUs than Whites, controlling for individual risk factors. We find no such effect within facilities after additional controlling for facility fixed effect. The effect of race is significantly different between the base and the conditional fixed-effects logit model. The random-effects and conditional fixed-effects logit models show similar results, demonstrating that higher PU presence among Blacks is associated with greater facility-specific concentration of Black residents. Conclusion Greater PU occurrence among Blacks may not result from differential within-facility treatment of Blacks versus Whites. Rather, Blacks are more likely to reside in facilities with poorer care quality. To improve PU care for Blacks, efforts should focus on improving the overall quality of care for facilities with high proportion of Black residents.

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Section: Introductionmentioning

confidence: 99%

“…The occurrence of pressure ulcers among nursing home residents is common (7, 13). The Centers for Medicare and Medicaid Services (CMS) consider pressure ulcer rates to be a quality indicator, and they publish facility-specific prevalence data on the Nursing Home Compare quality report card website.…”

Section: Introductionmentioning

confidence: 99%

Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State

Cai¹,

Mukamel²,

Temkin‐Greener³

2010

Medical Care

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“…Nursing homes are believed to lag behind acute care settings when it comes to institution-wide patient safety initiatives (Gruneir & Mor, 2008; Scott-Cawiezell & Volgelsmweier, 2006). Although, we should note that no comprehensive evaluation exists examining patient safety initiatives in nursing homes to make this determination.…”

Section: Introductionmentioning

confidence: 99%

Nursing Home Deficiency Citations for Safety

Castle

Wagner

Ferguson

et al. 2010

Journal of Aging & Social Policy

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Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational (i.e., characteristics of the facility itself) and external (i.e., characteristics outside of the influence of the organization) factors associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.

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“…In most jurisdictions, LTC is stringently regulated (Grunier and Mor 2008;Hollander 1994), and a vital aspect of LTCHs' operations is to ensure adherence to the standards set by government regulators; failure to do so may incur loss of provincial funding or of licensure. In Ontario, the Ministry of Health and Long-Term Care (MOHLTC) regulates and inspects all nursing homes that fall under the terms of the 2007 Long-Term Care Homes Act (LTCHA), and it is responsible for the granting of nursing home licences.…”

Section: Accountability Dynamism In Ontario' S Long-term Care Sectormentioning

confidence: 99%

Approaches to Accountability in Long-Term Care

Berta

Laporte

Wodchis

2014

hcpol

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This paper discusses the array of approaches to accountability in Ontario long-term care (LTC) homes. A focus group involving key informants from the LTC industry, including both for-profit and not-for-profit nursing home owners/operators, was used to identify stakeholders involved in formulating and implementing LTC accountability approaches and the relevant regulations, policies and initiatives relating to accountability in the LTC sector. These documents were then systematically reviewed. We found that the dominant mechanisms have been financial incentives and oversight, regulations and information; professionalism has played a minor role. More recently, measurement for accountability in LTC has grown to encompass an array of fiscal, clinical and public accountability measurement mechanisms. The goals of improved quality and accountability are likely more achievable using these historical regulatory approaches, but the recent rapid increase in data and measurability could also enable judicious application of market-based approaches. RESEARCH PAPERHEALTHCARE POLICY Vol. 10 Special Issue, 2014 [133] Approaches to Accountability in Long-Term Care Résumé Cet article porte sur l' organisation des démarches de l' obligation de rendre compte dans les résidences de soins de longue durée (SLD) en Ontario. Un groupe de discussion formé d'informateurs clés du secteur -des propriétaires ou gestionnaires de centres d'hébergement et de soins à but lucratif ou non -a été réuni pour déterminer qui sont les intervenants impliqués dans la définition et la mise en oeuvre des démarches d' obligation de rendre compte ainsi que de la réglementation, des politiques et des initiatives connexes dans le secteur des SLD. Ces documents ont été examinés systématiquement. Nous avons observé que les principaux mécanismes sont les mesures incitatives ainsi que le contrôle financier, la réglemen-tation et l'information; le professionnalisme y a joué un rôle secondaire. Plus récemment, l' évaluation de l' obligation de rendre compte dans les SLD s' est accrue pour inclure une gamme de mécanismes de mesures concernant l' obligation fiscale, clinique et publique. Il serait plus facile d' atteindre les objectifs d' amélioration de la qualité et d' obligation de rendre compte en utilisant ces démarches de réglementation traditionnelles, mais l' accroissement rapide des données et de la mesurabilité pourrait permettre une application judicieuse de démarches propres aux marchés commerciaux.

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Nursing Home Safety: Current Issues and Barriers to Improvement

Cited by 53 publications

References 95 publications

Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State

Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State

Nursing Home Deficiency Citations for Safety

Approaches to Accountability in Long-Term Care

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