9 new quality goals for nursing homes unveiled by initiative

In an effort to encourage nursing homes to collect and share data that may lead to uniform national standards and evidenced-based best practices, the Advancing Excellence in America’s Nursing Homes Campaign has released nine new quality goals and free toolkits to help facilities reach them.

“This effort demonstrates the campaign’s ongoing commitment to make nursing homes better places to live, work and visit,” says David Gifford, MD, MPH, senior vice president of quality and regulatory affairs for American Health Care Association and co-chair of the Advancing Excellence campaign.

The campaign, begun in 2006, is a coalition of long-term care providers, caregivers, medical and quality improvement experts, government agencies and consumers. Members aspire to establish standards and practices in line with the impending Centers for Medicare & Medicaid Services (CMS) Quality Assurance Performance Improvement, or QAPI, requirements and other government efforts.

More than 60 percent of the nation’s nursing homes (about 9,500) have joined the campaign, according to Cheryl Phillips, MD, senior vice president of advocacy for LeadingAge and co-chair of the Advancing Excellence campaign. Additionally, about 3,000 nursing home staff members and 3,600 consumers have signed on, she said in a conference call with members of the media.

The Advancing Excellence campaign is supported by 52 “local area networks of excellence” (LANEs). These state-level coalitions, the structure of which differs from state to state, are responsible for promoting the effort and engaging nursing homes in performance improvement. The LANEs disseminate campaign information and resources and organize statewide projects to improve nursing home performance related to campaign goals.

THE NINE GOALS

Gifford described the nine new quality goals — four process-related goals and five clinical goals — in the conference call. Facilities participating in the campaign commit to working on at least one process goal and one clinical goal.

Process goals:

• Improving staff stability. “We believe that addressing staff stability is a cornerstone to all the other work,” he said. “If you’re having high turnover, it’s hard to implement any sort of … clinical guideline.”
• Increasing use of consistent assignment. “The effort is to have the same staff taking care of the same individual each time they work,” Gifford said. “When you do that, the people know the residents, they know their likes, their dislikes. They know early, subtle changes when someone is getting ill. They know their routines. When you do the consistent assignment, you’re able to better achieve … person-centered care planning and decision-making.”
• Increasing person-centered care-planning and decision-making. “It’s really hard to figure out, if you don’t know the resident[s] you’re caring for, what time they like to wake up, whether they like to bathe or shower, what music they like to listen to, what type of foods they like, whether they like to snack or not, whether they like coffee or tea,” Gifford said. “And when you have a consistent assignment, you can actually do much better person-centered planning and decision-making and really tailor the care level to the individual needs, which is what we all want for our family members and ourselves should we ever need to be in a nursing home.”
• Safely reducing hospitalizations. “It turns out that a lot of these issues about consistent assignment, staff stability, communicating between the nurses and physicians, early detection of … subtle changes in individuals, understanding people’s likes and dislikes, particularly around end-of-life counseling — all of those are critical information for figuring out how to reduce hospitalizations,” Gifford said.

Clinical goals:

• Using medications appropriately. Of this new goal, Gifford said: “We know that the elderly in general are on many medications. Those in nursing homes are on even more medications, and a lot of the medications contribute to many of the problems and poor outcomes.” The Advancing Excellence campaign initially will focus this goal on reducing the use of antipsychotic drugs in individuals with dementia, he said, because doing so aligns with the CMS dementia collaborative as well as the national strategy for Alzheimer’s disease.
• Increasing resident mobility. “Getting people up and moving around is critical to their overall health,” Gifford said, adding that mobility efforts help prevent falls and pressure ulcers.
• Preventing and managing infections safely. This Advancing Excellence goal initially will focus on Clostridium difficile prevention and reduction, Gifford said, noting that the group is partnering with the Centers for Disease Control and Prevention in efforts to promote effective use of antibiotics, since overuse or misuse can lead to illness and hospitalizations.
• Reducing the prevalence of pressure ulcers. Gifford said that this goal and the one of decreasing pain symptoms have been the focus of national efforts and the Advancing Excellence campaign for some time.
• Decreasing symptoms of pain.

The campaign added, dropped or combined some former goals as it aligned its efforts with other national efforts, Gifford said. For instance goals related to hospitalizations, medication use and infection management are new, and goals related to restraints and falls were absorbed into the new goal related to mobility. The new goals focus more on person-centered care-planning and decision-making than former goals, he added.

CULTURE CHANGE

Mary Jane Koren, MD, MPH, vice president of long-term care quality improvement for the Commonwealth Fund, which has provided financing for the campaign, said that facilities’ efforts toward meeting the goals must extend beyond nursing departments and “all the way up to the owners of the nursing home and others.”

Working toward the goals, she added, requires a culture change within organizations. “It’s moving from a quality assurance kind of mindset into a performance improvement mindset,” Koren said. “What we’re looking for is a proactive approach and positive change.”

When asked what incentives nursing homes have to participate in the campaign, Phillips said that participants will not receive a “pass from survey” from CMS, but they potentially will experience more stable staffing and will gain a chance to illustrate the facility’s commitment to quality, which it can use to differentiate itself from others in the market. Koren added that facilities striving to meet campaign goals will be more comfortable with QAPI tools and processes by the time they are required and that they will be able to position themselves as partners with hospitals in reducing readmission rates. Gifford said that successful nursing homes can expect fewer survey deficiencies.

Phillips said that assisted living and other congregate housing facilities are welcome to use the tools.

Those interested in learning more may register online for a free Advancing Excellence Web seminar Sept. 10 at 3 p.m. ET.

Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.