Sarita L. Karon

Using indicators to structure quality improvement initiatives in long-term care.

Quality indicators and a quality-monitoring system developed for use in the regulatory survey process offer a quality improvement tool for nursing home staff. The systematic use of resident assessment data can aid in the identification of quality of care problems and the determination of the nature of those problems. This approach is particularly useful for continuous quality improvement efforts.

Users Of Medicaid Home And Community-Based Services Are Especially Vulnerable To Costly Avoidable Hospital Admissions

Although Medicaids coverage of home and community-based services and the programs capacity to provide such services have increased markedly in recent years, relatively little is known about the population that uses these services. We combined Medicaid and Medicare data to characterize the national Medicaid population of service users by key demographic and health-related attributes. We also assessed one important dimension of their health outcomes: potentially avoidable hospital admissions. We found that in 2005 there were 2.2 million users of Medicaid home and community-based services-almost 4 percent of the total Medicaid population-and that two-thirds of these users were dually eligible for Medicare and Medicaid. Users of home and community-based services were particularly vulnerable to avoidable hospital admissions, compared to the full Medicaid and US populations, and these hospitalizations occur at substantial cost to public payers. For the dual eligibles using home and community-based services, Medicare pays most of the costs of these avoidable hospital stays. Our findings emphasize the need for further research to establish policies and practices that can best meet the needs of users of Medicaid home and community-based services.

ANA nurse sensitive quality indicators for long-term care facilities.

Nurse sensitive quality indicators, developed through the American Nurses Associations (ANA) Safety and Quality Initiative, are key to evaluating the quality of patient care in acute care settings. This study found that the ANA quality indicators were also relevant for long-term care facilities. Long-term care facilities can be part of the ANA Safety and Quality Initiative by collecting and reporting nurse sensitive quality indicators and submitting data to the National Database of Nursing Quality Indicators.

Chapter 4 Residential Care Supply and Nursing Home Case Mix

Abstract An evolution is occurring in state policy and industry practices relative to assisted living and expanded use of residential care facilities (RCFs) for persons with physical and cognitive frailty, yet relatively little is known about the interrelationship between this housing supply and nursing home case mix. This article summarizes an analysis of these relationships. The findings raise caution about the optimistic assumptions of the interplay between RCF policy and nursing home use. The proportion of nursing home cases with only physical and cognitive impairment likely to be affected by emerging long term care policy appears to be much less than 25%.