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Quiet coalition is registering gains for LTC excellence

December 1, 2008
by Richard L. Peck, Editor-In-Chief
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The challenge intensifies when facilities within that system are attempting to make profits, sustain margins, or otherwise survive as viable businesses. Not surprisingly, this has spawned a variety of initiatives aimed at enhancing quality of long-term care, including government-sponsored survey agencies and quality improvement organizations and large umbrella campaigns sponsored by professional associations to assist their members in achieving modern quality expectations.

Quiet coalition Relatively quietly compared to these, however, has emerged a coalition of 28 national organizations, including the federal Centers for Medicare & Medicaid Services, involved with statewide, multi-stakeholder networks in 49 states (North Dakota excepted). Nearly half of U.S. nursing homes have signed up for this campaign, called Advancing Excellence in America’s Nursing Homes, since its inception in 2006.

Advancing Excellence celebrated its second anniversary this past October by issuing a progress report on how well members have performed in four of eight key areas of nursing home performance. Members have exceeded nonmember facilities in achieving measurable improvement in pressure ulcer reduction, reducing physical restraint use, and controlling or relieving pain in short- and long-stay residents, according to the report. In fact, the physical restraint reduction has already met one of the campaign’s national objectives.

Perhaps the most heartening aspect of all this, says Mary Jane Koren, MD, MPH, chair of the Advancing Excellence Campaign and assistant vice president of the Commonwealth Fund, is that the effort is a genuine collaboration of providers, staffing groups, consumers, and consumer advocates pitching in from their own perspectives to help nursing homes advance. Finger-pointing, punitive actions, and holier-than-thou posturing have been kept to a minimum.

Some within long-term care say that Advancing Excellence faltered in adopting an uncritical stance

Perhaps the most heartening aspect of all this is that the effort is a genuine collaboration to help nursing homes advance.

on a recent Housing and Human Services Inspector General’s report finding that more than 90% of facilities experienced survey deficiencies last year—a figure that, unanalyzed by media coverage, was imprecise to the point of tarring the entire industry with a very black brush. The Inspector General’s own careful definitions and qualifications were largely overlooked in the coverage, prompting provider resentment.

Dr. Koren says she sympathizes with providers’ frustrations, especially those who are doing their best under adverse circumstances to improve conditions for residents and staff. Not only working to improve quality, but being seen doing so, as in an Advancing Excellence program, could help, she says.

Improvement in staffing Staffing improvement is among those campaign goals that needs significant attention going forward, she says. (Among its “nonclinical” goals, the campaign aims at increased staff retention and adoption of consistent assignment of staff in resident care.) “Many nursing assistants love the work but hate the job,” she notes. “A lot of progress depends on making the work environment better—not just money, but respect, appreciation, recognition, and empowerment, defined as acquiring the skills and knowledge to do their jobs well.”

Dr. Koren adds that this is a major area of needed improvement for Advancing Excellence itself. “Nursing homes have to report their own data to us on retention and recruitment, and it has been difficult to get them to do so. We need this data, in the aggregate of course, to show whether our staffing measures are working. That in itself would create a positive feedback loop—recognizing staff progress and encouraging them to continue it.”

In the last analysis, it’s all about “show-and-tell,” whether to residents, families, staff, or the nation at large. It has been a concept that has worked with school kids since time immemorial. Advancing Excellence is bringing it to bear in an industry that would welcome the assistance.

Mary Jane Koren, MD, MPH, is Chair of the Advancing Excellence Campaign and Assistant Vice President of the Commonwealth Fund. For more information or to join the Advancing Excellence Campaign, go to http://www.nhqualitycampaign.org.

To send your comments to the editors, e-mail rpeck@vendomegrp.com.

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