Quality Care Nursing Homes

Nursing Homes are charged with providing quality care to all of their residents. They are monitored by the state and federal agencies for the type of care they are giving to patients. Nursing Home standards have been raised and a tool which identifies quality indicators was developed by HCFA to monitor nursing home residents care.

Quality indicators are markers that point to either the presence or absence of potentially poor care practices or outcomes. Some indicators will identify health or functional conditions that may increase or decrease the residents chance of developing a specific conditions.

Quality indicators is a useful tool for facilities to implement performance improvement initiatives when the indicators are suggestive of a potential or actual problem. There are 24 quality indicators and they are as follows:

The incidence of a person not being able to feed them selves increase with advance age. Poor nutrition and dehydration are common in nursing home residents and are associated with many adverse clinical outcomes.

Jones states that mealtime problems in nursing homes are widespread, interdisciplinary and serious. Feeding or assisting residents at mealtime is one of the most time- consuming, but also one of the most important, aspects of care. If residents are not fed adequately, they will become malnourished and dehydrated. Malnutrition is serious and common adverse clinical outcome in nursing homes. It is often avoidable if staff took the time to feed residents properly.

According to Jones studies reveal that 35 to 85% of nursing home residents are malnourished, despite state and federal regulations designed to ensure adequate nutrition.

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A study showed that 1 out of 40 residents received adequate fluid intake. Inadequate fluid intake leads to other serious medical conditions such as urinary tract infections, pneumonia, kidney dysfunction pressure ulcers etc. All of which can cause death in the elderly population. Nursing home staff are not accurately documenting the fluid intake of the residents.

In most cases they are recording a higher percentage of intake than what actually was consumed. Kugler (2000) states that Clinicians should have a clear appreciation of the roles that iatrogenic interventions and lapses in nutrition and nursing care frequently play in upsetting the homeostatic balance in elderly patients, particularly those who are in long-term institutional and inpatient settings.

The use of psychotropic medication is a quality indicator that has proven to increase the quality of patient care. Hughes (2000) states that excessive use of psychotropic medication was commonplace in nursing homes in the United States before the Nursing Home Reform Act 1987 was passed. After legislation, psychotropic drugs were used less and a more structured approach to care planning was observed.

Before the Nursing Home Reform Act, psychotropic drugs were used widely in US nursing homes. These drugs were prescribed for 43%-55% of patients in homes without documented justification for usage. The nursing home reform act require that comprehensive documentation justifying the need for psychotropic drugs. All medications received by residents should be medically necessary. No resident’s drug regimen should include drugs that are not medically necessary defined as drugs used in excessive doses, for too long, without adequate indications, or in the face of adverse consequences indicating that the dose should be reduced or the drug stopped.