Defining Quality in Nursing Homes Flashcards
What is the Omnibus Budget Reconciliation Act of 1987 (OBRA 87)?
Quality of Life emphasized Resident Assessment Instrument (admission, annually and w/ status change) MDS (Minimum Data Sets) RAP (Resident Assessment Protocols) Led to QI/QM development
What is the minimum data set?
Federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes.
Comprehensive assessment of each resident’s functional capabilities & identification of health problems.
Resident Assessment Protocols (RAPs)
Version 3.0 launched October 2010
Tested in 71 community NHs and 19 VHA NHs
Takes 45% less time to complete (than 2.0)
Gives residents a greater voice
Assessment based on evidence e.g., PHQ-9 Depression scale, Braden PrU assessment scale etc.
What are Resident Assessment Protocols (RAPs)?
Resident Assessment Protocols (RAPs), are part of the MDS process, and provide the foundation upon which a resident’s individual care plan is formulated.
Describe OBRA definition of quality of life.
Nursing facilities must care for residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident.
Describe OBRA definition of Quality of Care
Nursing facilities must provide services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, in accordance with a written plan of care.
Describe OBRA definition of Residents’ Rights?
Nursing facilities must protect and promote the rights of each resident, including each of the following rights… and it lists eleven rights in detail.
Three important provisions of OBRA 87 include:
Quality of Life
Quality of Care
Residents’ Rights
Which regulations (federal vs. state) provide the minimum standard of care and what does that mean?
Notice that the law applies to each resident. That standard places an appropriate and heavy responsibility on nursing homes to meet every resident’s individual needs.
A second important word is must. Nursing homes have no choice but to meet these standards.
Federal Regs define the minimum standard of care.
What was the effect of the OBRA provisions?
Changed the emphasis of care from a medical model to psychosocial model. Holistic model of care.
The survey, certification, and enforcement final rule from HCFA published in 1985 began the final phase in implementing the nursing facility reform provisions of OBRA.
On the survey side, the rule defined what constituted compliance as well as how and to what extent facilities would be subject to enforcement actions for failing to meet the standards.
On the enforcement side, the rule made possible a broader array of potential enforcement actions against nursing facilities, including civil money penalties.
What was included in the OBRA provisions?
Facilities have a Medical Director
Mandated nurses aide training and certification
Licensed nurses around the clock including RNs every day
Pre admission assessment
Comprehensive assessments (MDS) within 14 days
Plan of care based on the above assessment
Quality Assurance
Social Workers
Qualified Dietician
Activities Programs
Rehabilitative Services
Independent Consultant monitoring psychopharmacologic drugs
What is the HCFA checklist for what makes a good nursing home?
Choice in daily routine Resident well groomed and dressed Facility looks and smells clean Staff and residents interact warmly Choice in food Religious and spiritual needs met Robust Quality Improvement process
What is the system in place to evaluate quality in the nursing home?
Department of Health Inspections: for all facilities participating in Medicare/Medicaid
Conducted every 12-15 months (annual survey), as well as, complaint surveys
180 regulatory standards evaluated
What is a standard survey and what does it assess?
Based on specific procedures, the standard survey assesses:
Compliance with resident’s rights and quality of life requirements.
Accuracy of comprehensive assessment and adequacy of care plans based on these assessments.
Quality of care and services furnished as measured by indicators of medical, nursing rehabilitation, drug therapy, nutritional services, activities and social participation, sanitation, and infection control.
What is the role of an extended survey?
conducted after substandard quality of care is found during a standard survey.
What is an abbreviated standard survey?
this survey focuses on particular tasks that related, for example, to complaints received or a change of ownership, management or Director of Nursing.
What is the purpose of the survey?
Inspections determine “minimum standards”
If standards are not met in certain areas, citations are given
Inspection results are public documents
Deficiencies may have associated monetary fines and/or other penalties
