News Release

Nursing Home Care Improving in Many Areas New CMS Data Show, New Steps Initiated

HHS Secretary Tommy G. Thompson announced today that fewer nursing home residents suffer from chronic pain and fewer physical restraints are being used, according to data collected by the Centers for Medicare & Medicaid Services (CMS) two years after the launch of the HHS Nursing Home Quality Initiative (NHQI).

In addition to tracking quality measures as a way to improve long-term care, CMS is also beginning a new phase of initiatives to further improve care for seniors.

The new data show that 100 percent of states report a decrease in the prevalence of chronic pain in nursing home patients statewide since Secretary Thompson launched the NHQI in November 2002. Fully 92 percent of states also show declines in the use of physical restraints, according to the CMS data. Nationally, the prevalence of long-term pain decreased by 38 percent and the use of physical restraints declined by 23 percent.

"By working together, we're creating a higher quality of life for seniors in nursing homes and having a meaningful impact on the care they receive," Secretary Thompson said. "Improvements in quality mean improvements in the lives of nursing home residents as well as peace-of-mind for their families. The improved outcomes are a great first step, but we know much more can be done. In fact, we are initiating an aggressive new phase in our quality initiative that will further strengthen our enforcement actions when a nursing home fails to measure up."

The HHS Nursing Home Quality Initiative includes the following features:

• Strengthening CMS' regulatory and enforcement activities to better track and address complaints and deficiencies;
• Improving and expanding the consumer information available at www.medicare.gov;
• Strengthening the community-based nursing home quality improvement programs coordinated by the Medicare Quality Improvement Organizations (QIOs) with local nursing homes; and
• Expanding partnerships with state survey agencies, nursing homes, residents and their family members and staff members to accelerate changes in nursing homes and how they deliver care.

"It is clear that the steps we are taking can help achieve important improvements in nursing home culture, practices, and results," said Mark B. McClellan, M.D., Ph.D., administrator of CMS. "In this unprecedented effort to improve quality nationally, I am very encouraged by the determination and effort of beneficiary groups, the nursing home industry, health professionals, and our QIO partners to make significant improvements in care for many of our nation's most frail and vulnerable citizens."

As part of its aggressive action plan for nursing home improvements, CMS is undertaking the following initiatives:

• Expand the information on www.medicare.gov to help families evaluate quality in nursing homes, including accurate information about staffing levels and a new quality measure related to weight loss in long-term, chronic care nursing home residents;
• Strengthen the investigation of complaints from residents, family members, and others by requiring states to use a standard complaint tracking system that will help to better track and analyze complaints, building on increased complaint investigations conducted by CMS or States in nursing homes (from about 45,700 in FY 2000 to about 48,900 in FY 2003);
• Prevent neglect and abuse by implementing a pilot program with up to 10 volunteer states to pilot expanded and more effective systems of background checks for individuals seeking employment in nursing homes and other long-term care (LTC) providers;
• Improve fire safety by increasing the number of comparative life-safety surveys and issuing a regulation requiring smoke detectors in areas of nursing homes that do not have automatic sprinklers;
• Conduct annual performance reviews of state survey agencies to assess whether complaints are investigated in a timely manner;
• Continue and expand partnership efforts with nursing home residents and their family members, the nursing homes themselves, unions representing nursing home staff, state survey agencies, and other local and national organizations working to improve the quality of care available in nursing homes;
• Improve the accuracy of the Medicare payment systems, to improve access for those with the greatest care needs; Direct the appropriate level of resources to nursing homes to furnish high quality care, including performance incentives related to quality; and
• Develop a more refined indicator and better tracking of the incidence of pressure sores to achieve greater nursing home progress in that area.

"In many areas we are seeing marked progress in the care that nursing homes provide, and now we are enhancing our quality improvement efforts, " said Dr. McClellan. "We have established a task force that will not just provide agency-level coordination and leadership CMS, but will also work with states, consumer organizations, providers, and others who share the goal of improving quality. We all have vital roles to play if we are to be successful."

CMS is also working with the National Quality Forum, a voluntary, standard-setting organization representing public and private purchasers, providers, consumers, and researchers to identify quality measures that are considered to be the most important to consumers and nursing homes. The measures reported by CMS are in eight clinical topics; five reflect care given to those with chronic conditions (physical restraints, pressure sores, infections, pain management, and declines in activities of daily living) and three reflect post-acute care (delirium, pain management, and improvement in walking).

Several of these measures showed marked improvement since the beginning of the initiative, and the improvements are larger in nursing homes that worked most closely with their QIOs. For example, nursing homes working intensively with their QIO have decreased the prevalence of pain in long stay residents by an average of 49 percent, the use of physical restraints by 33 percent and the prevalence of pain in short stay residents by an average of 18 percent.

Medicare is continuing to work aggressively to improve performance on other measures. One area in need of improvement is the prevalence of pressure ulcers. Data show nursing homes working intensively with QIOs may be nearing a turning point for decreasing the prevalence of residents' pressure ulcers. Nationwide, the percentage of patients with pressure ulcers has risen slightly since measurements began in June 2002, from 8.5 percent to 8.7 percent. However, a smaller group of nursing homes that worked very intensively with QIOs showed a decrease in pressure sores from 10.1 percent to 9.3 percent.

"We have clear evidence that improved quality of care is an achievable goal," said Dr. McClellan. "We will keep building on our initiatives until the all people who need nursing home care are receiving the quality of care they deserve.

The updated information is available at Nursing Home Compare at www.medicare.gov. Those without Internet access may call 1-800-MEDICARE (1-800-633-4227) for assistance.

New Background Check Programs Launched

As part of the quality initiatives, Dr. McClellan also today named seven states to participate in comprehensive background check programs for new workers in long-term care facilities, as another way to combat abuse and neglect in these facilities.

"Checking the backgrounds of those applying for jobs involving direct patient care in long-term care facilities is a good way to weed out those individuals who have criminal backgrounds or other disqualifying factors in their histories," said Dr. McClellan.

The two-year pilot will help determine the impact of national background checks for any new worker with direct patient care duties on abuse and neglect in nursing homes and other long-term care facilities. States named to conduct the pilots include Alaska, Idaho, Michigan, Nevada, New Mexico, South Carolina and Wisconsin.

Questions about the background check pilot program can be e-mailed to backgroundchecks@cms.hhs.gov.

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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

Last Revised: December 22, 2004