Many Americans remain concerned about the quality of care in nursing homes. A recent study shows that these concerns may be justified. It found that quality-of-care problems persisted in the Nation's nursing homes from 1991 to 1997. Problems included poor food sanitation, failure to conduct comprehensive patient assessments and to develop care plans, poor accident prevention efforts, and failure to prevent pressure sores.
The study was based on trend data collected by State surveyors during annual licensing and certification surveys of federally certified nursing home facilities in the United States. State surveying agencies are contracted by the Health Care Financing Administration (HCFA) to conduct periodic surveys to ensure that nursing homes meet Federal care standards outlined in the 1987 Nursing Home Reform Act. Survey data are included in HCFA's On-Line Survey, Certification, and Reporting System (OSCAR).
The study was jointly supported by the Agency for Healthcare Research and Quality (HS07574) and HCFA, and conducted by Charlene Harrington, Ph.D., of the University of California, San Francisco. The data revealed that during the 1991-1997 period, nursing home residents became more dependent and sicker. Of the total facilities studied, 17 percent were given deficiencies by State surveyors for failure to conduct appropriate resident assessments, 17 percent for failure to prepare comprehensive resident care plans as required, and nearly 16 percent for failure to keep the environment free of accident hazards. In 1997, 16 percent of facilities received deficiencies for failure to ensure that residents would not develop pressure sores, 14 percent failed to meet the general quality-of-care requirement; and nearly 11 percent were cited for unnecessary and inappropriate use of medications.
However, it was puzzling that the average number of deficiencies reported by State surveyors for facility quality-of-care violations declined by 44 percent between 1991 and 1997 (from 8.8 to 4.9 deficiencies per facility). There was also a 100 percent increase in the number of facilities with no deficiencies, and there were wide variations in patterns of deficiencies issued across States. The reasons for these discrepancies could not be explained by analysis of the study data and remain unclear. Dr. Harrington theorizes that either quality of care is improving in nursing homes, or the survey process is inconsistent.
More details are in "Regulation and enforcement of Federal nursing home standards, 1991-1997," by Dr. Harrington, in the December 1999 Medical Care Research and Review 56(4), pp. 471-494.