Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals

In 1998, Medicare began phasing in a new prospective payment system (PPS) for skilled nursing facilities (SNFs). This paper measures facility-level changes in nurse staffing and quality at freestanding SNFs from 1997 (pre-PPS) to 2001 (post-PPS). Findings show a positive but small association between changes in payment levels and changes in nurse staffing. Among for-profits, the elimination of cost reimbursement is associated with a large drop in nurse staffing. Additionally, the elimination of cost reimbursement is associated with worsening in one of four measures of quality of care; however, the quality results are not statistically robust.

Download Full-text

Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients

The Journals of Gerontology Series A ◽

10.1093/gerona/gly089 ◽

2018 ◽

Vol 74 (5) ◽

pp. 689-697 ◽

Cited By ~ 3

Author(s):

Maricruz Rivera-Hernandez ◽

Momotazur Rahman ◽

Dana B Mukamel ◽

Vincent Mor ◽

Amal N Trivedi

Keyword(s):

Acute Care ◽

Skilled Nursing Facilities ◽

Nursing Facilities ◽

Skilled Nursing ◽

Hispanic Patients ◽

Post Acute Care

Download Full-text

Does Investor-Ownership of Nursing Homes Compromise the Quality of Care?

International Journal of Health Services ◽

10.2190/ebcn-wecv-c0nt-676r ◽

2002 ◽

Vol 32 (2) ◽

pp. 315-325 ◽

Cited By ~ 32

Author(s):

Charlene Harrington ◽

Steffie Woolhandler ◽

Joseph Mullan ◽

Helen Carrillo ◽

David U. Himmelstein

Keyword(s):

Quality Of Care ◽

Nursing Homes ◽

Skilled Nursing Facility ◽

Nurse Staffing ◽

Care Quality ◽

Nursing Facilities ◽

Skilled Nursing ◽

Staffing Ratios ◽

The Impact

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

Download Full-text

Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Hispanics With Dementia

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.06.030 ◽

2020 ◽

Vol 21 (11) ◽

pp. 1705-1711.e3

Author(s):

Maricruz Rivera-Hernandez ◽

Chanee D. Fabius ◽

Shekinah Fashaw ◽

Brian Downer ◽

Amit Kumar ◽

...

Keyword(s):

Acute Care ◽

Skilled Nursing Facilities ◽

Nursing Facilities ◽

Skilled Nursing ◽

Post Acute Care

Download Full-text

Determinants of Quality of Life in Older Adults After Lower Limb Amputation and Rehabilitation in Skilled Nursing Facilities

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2011.03880.x ◽

2012 ◽

Vol 60 (4) ◽

pp. 796-798 ◽

Cited By ~ 7

Author(s):

Bianca I. Buijck ◽

Sytse U. Zuidema ◽

Monica S. van Eijk ◽

Debby L. Gerritsen ◽

Raymond TCM Koopmans ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Lower Limb ◽

Lower Limb Amputation ◽

Skilled Nursing Facilities ◽

Limb Amputation ◽

Nursing Facilities ◽

Skilled Nursing

Download Full-text

Preliminary Report of a Pilot Tele-Health Palliative Care and Bioethics Program for Residents in Skilled Nursing Facilities

Palliative Care Research and Treatment ◽

10.4137/pcrt.s3296 ◽

2009 ◽

Vol 3 ◽

pp. PCRT.S3296

Author(s):

Sean O'Mahony ◽

Patricia Marthone ◽

Gabriella Santoro ◽

Clare Horn ◽

Sandy Selikson ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Skilled Nursing Facilities ◽

Rank Test ◽

Nursing Facilities ◽

Life Care ◽

Skilled Nursing ◽

Face To Face

Currently about 25% of Americans die in nursing homes, many with poorly controlled pain and other symptoms, with minimal provisions for psychosocial support. New models are necessary to lessen structural and process barriers to give effective end-of-life care in nursing homes. Objectives 1) To extend hospital-based Bioethics Consultation Services (BCS) and Palliative Care Services (PCS) at Montefiore Medical Center (MMC) in the Bronx to two local Skilled Nursing Facilities (SNFs), Morningside House Aging in America (MSH) using direct face-to-face consultations and Beth Abraham Health Systems (BAHS) via video consultations (VC); 2) Achieve improvements in quality of life and comfort for elderly residents and their families; 2a) Improve the level of practice and increase staff satisfaction with palliative care content-related knowledge and bioethical analysis. Methods We report preliminary findings of this two group quasi experimental project with results of pre- and post-tests rating content-related knowledge in aspects of end-of-life care for staff. Select pre-test and post-test questions were given to physicians and other staff, but were re-configured for, registered and licensed practice nurses, social workers, and certified nursing assistants from the End-of-Life Physician Education Resource Center (EPERC). Patient, family, and staff ratings of the quality of palliative care were measured with a Palliative Outcomes Scale (POS) one week prior to and post consultation. Results 72 staff attended in-services; 53 completed pre-tests and 49 post-tests. Overall knowledge scores increased for 9 of the 16 items that were analyzed. There were improvements in knowledge scores in 12 of 16 items tested for staff content related knowledge which were statistically significant in regard to management of cancer pain from 63.8% to 81.5% (p = 0.03) and a trend to significance for assessment and management of delirium from 31.6% to 61.9% (p = 0.073). Seventy five POS surveys were completed from 13 video-conferenced Palliative Care consultations and 14 direct face-to-face consultations from March 2008 to January 2009. There were improvements in ratings for some aspects of quality of care on the POS. Patient and staff aggregate response scores for the POS were significantly improved between baseline and follow-up (Wilcoxon signed-rank test p = 0.0143 and p = 0.005) at the videoconsultation site and for family and staff at the face-to-face consultation site (Wilcoxon signed-rank test p = 0.0016 and p = 0.0012). Conclusion Preliminary evidence suggests that use of real time videoconferencing to connect hospital-based Bioethics and Palliative Care clinicians with patients, families, and staff in Skilled Nursing Facilities may enhance some aspects of end-of-life care for their residents, as well as content related knowledge in core aspects of end-of-life care for interdisciplinary groups of staff or caregivers.

Download Full-text

Understanding the True Quality of Skilled Nursing Facilities: Will Stars Suffice?

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2018.06.003 ◽

2018 ◽

Vol 19 (10) ◽

pp. 816-817 ◽

Cited By ~ 2

Author(s):

Arif Nazir

Keyword(s):

Skilled Nursing Facilities ◽

Nursing Facilities ◽

Skilled Nursing

Download Full-text

THE SHARED MEANING OF COMPASSION FATIGUE AMONG REGISTERED NURSES WORKING IN SKILLED NURSING FACILITIES

Innovation in Aging ◽

10.1093/geroni/igz038.2586 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S703-S703

Author(s):

Marlene Steinheiser

Keyword(s):

Patient Care ◽

Registered Nurses ◽

Compassion Fatigue ◽

Skilled Nursing Facilities ◽

Future Research ◽

Nursing Facilities ◽

Shared Meaning ◽

Emotional Symptoms ◽

Skilled Nursing

Abstract The purpose of this hermeneutic interpretive phenomenology study was to describe the shared meaning of compassion fatigue (CF) among registered nurses (RNs) who work in skilled nursing facilities (SNFs). The specific aims were to describe: 1) contributors (triggers, situation, or patient characteristics) that cause symptoms of compassion fatigue, 2) associated physical and emotional symptoms, and 3) the short-term outcomes of unresolved compassion fatigue impacting nurses and patient care. CF can negatively impact patient outcomes, is associated with decreased quality of patient care, and can be a reason why nurses leave the profession. Eight participants were interviewed three times each, while concurrent data analysis helped to formulate mutual understanding of the phenomenon and informed subsequent interviews. Self-reflection, journaling, record keeping, and use of direct quotes enhanced trustworthiness. Four shared meanings were abstracted:1) I feel conflicted and that causes my CF; 2) physical and emotional manifestations of CF; 3) CF is infused in every aspect of my life; 4) we are trying to cope with CF. The participants shared their central desire to make a difference in the lives of their patients, which was of paramount importance. When participants felt they were unable to make the desired difference, they began to develop symptoms of CF. Symptoms were compounded when they experienced frequent patient deaths. A resiliency program specifically addressing the needs of SNF nurses, incorporating individuals and their organizations, could positively impact the nurses’ professional quality of life. Future research is needed to better understand CF and interventions specific to SNF nurses.

Download Full-text