Elderly/Long-term Care

Nursing home report cards have prompted many nursing homes to improve care, especially those with poor scores

Concerns have persisted about malnutrition, pressure ulcers, medication errors, and other problems reflecting poor quality of care in nursing homes. These concerns prompted the Centers for Medicare & Medicaid Services (CMS) in 2002 to publish quality report cards for all nursing homes in the country. These report cards have prompted many nursing homes, especially those with poor scores, to take actions to improve care according to a survey of 724 nursing home administrators.

In response to the scores, 42 percent of nursing homes changed priorities of existing quality assurance programs and 20 percent were motivated to start new programs. To improve their quality of care, nursing homes most commonly changed care protocols (36 percent changed existing protocols and 28 percent developed new protocols) and trained staff for the specific quality measure in which the facility had a poor score (36 percent).They were less likely to increase staff or add new equipment or technology, which requires additional resources, notes William D. Spector, Ph.D., of the Agency for Healthcare Research and Quality.

Nursing home report cards examine quality measures for short- and long-term residents. Measures for long-term residents range from the percentage of residents who lose their ability to perform basic daily tasks to the percentage who suffer from pressure ulcers, pain, or infections.

Measures for short-term residents range from the percentage of residents with delirium to the percentage who walk better than when they arrived. About 60 percent of nursing home administrators believed that care quality influenced their scores, even though they felt other factors also played a role. However, they didn't feel the report cards had much influence over consumers, who never inquired about their facility's quality score.

See "Nursing homes' response to the nursing home compare report card," by Dana B. Mukamel, Ph.D., Dr. Spector, Jacqueline S. Zinn, Ph.D., and others, in the Journal of Gerontology: Social Sciences 62B (4), pp. S218-S225, 2007.

Reprints (AHRQ Publication No. 07-0080) are available from the AHRQ Publications Clearinghouse.

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