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Colorado reforming nursing homes

Published on December 8th, 2008

The Denver Post had an interesting article about new developments in elder care.  Facilities are trying to move away from institutional settings and make resident’s stay feel more like home.

The article states that "a generation of retirees resists the fate of nursing homes they’ve grown to dread, supporters of a cultural revolution say they are reforming an industry long tainted by images of neglected patients languishing on soiled sheets".

Reforms will likely quicken in the next year as Colorado begins sending higher Medicaid payments to homes that make changes ranging from reducing bed sores to giving residents a peanut-butter sandwich on demand.   Critics of traditional nursing- home care are not ready to declare lasting success. Reforms at a given home too often depend on the energy and dedication of a few key staff members, and those changes are difficult to replicate in more than 16,000 nursing homes nationwide.

"In general, the quality of nursing-home care is really bad," said Charlene Harrington, a professor of sociology and nursing at the University of California at San Francisco who has studied national reforms. Truly improving care almost always requires increasing staff, she said.

"There’s some basic merits to the idea of the culture-change movement," Harrington said. But "the nursing-home industry is trying to promote the idea you don’t need the staff; you just change the culture. That’s why I’m skeptical of the whole effort."

"The heart of it is just treating people the way you want to be treated," said Barbara Moore, administrator of Bruce McCandless Colorado State Veterans Nursing Home in Florence. Once entrenched in a notorious state nursing system, McCandless has won kudos for trying everything from consistently matching staff with the same patients to parking a Patton tank outside for grandkids to climb on.

Promotion of culture change or comparable reforms is vital for baby boomers who want to avoid mass warehousing in the coming decades. The U.S. population 65 and older will jump from 40 million in 2010 to 55 million in 2020, according to the federal Administration on Aging.

The vulnerable population 85 and older, meanwhile, will need many new care beds, with the population in that oldest group rising from 6.1 million to 7.3 million that same decade.
By all accounts, they want to avoid the nursing homes of their parents’ day.

Another Medicare and Medicaid report in September said that more than 90 percent of U.S. nursing homes were cited for violating federal standards in the past three years, but those transgressions can range from improper food storage to acute medical problems.
Caring for the elderly, meanwhile, consumes a good share of the state budget.

In Colorado and across the country, nursing-home occupancy rates are flat or dropping even as the population ages. More families are keeping aging relatives at home, hiring home-health aides, or choosing newer and smaller assisted-living sites for patients who don’t need extensive medical care.

Culture change can be as varied as adopting a cow for a pet or building a $1 million adapted home from the ground up to house only six residents — but the basic tenets across the country are consistent:

• Breaking from institutional schedules and rules in which residents must eat at common times or take showers at a rigid hour set by the staff.

• Training staff in resident-centered care and reassigning employees to more-consistent jobs.

• Some attempt to alter the physical monotony of nursing-home settings dominated by institutional 1960s and ’70s architecture. Larger homes may parcel themselves into "neighborhoods;" others renovate with resident input on colors and materials; still more add gardens, meditation rooms or restaurant-style dining areas.

A national survey of the transformation of nursing-home culture found that 31 percent of homes had adopted significant portions of the movement. The results "indicate a hopeful picture about the potential for deep, systemic change within the industry," according to the Commonwealth Fund.

Proponents believe the new state reimbursement system for Medicaid will eliminate any reason not to participate in the changes being made.  Culture change is not more expensive in the long run — it can save on staff turnover, food costs and expensive acute care. But for managers concerned about immediate costs, the state program to come on line next summer offers immediate financial rewards.

Nursing homes will earn points for quality of medical care, satisfaction of patients and their families, and culture-change tenets like consistent staffing and resident-controlled decisions. A home that scores 100 points will receive $4 more per Medicaid patient per day (on top of the current Medicaid rate of about $178 a day).

Medicaid pays for about 63 percent of nursing-home residents; the new payment system will mean, for example, that a high-scoring home with 70 Medicaid patients could earn an extra $8,400 a month. The first year of the program will cost $4 million, half coming from the federal government and half from a new fee charged to all nursing homes.

 

Joe Pioletti
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