rti international is a trade name of research triangle institute
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Strategies for Improving the Quality of Long-Term Care Presented by Joshua M. Wiener, PhD, Marc Freiman, Ph.D., and David Brown, M.A. RTI International. 701 13 th Street, NW ■ Suite 750 ■ Washington, DC 20005. Phone 202-728-2094. Fax 202-728-2094. e-mail [email protected]. - PowerPoint PPT PresentationTRANSCRIPT
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Strategies for Improving the Quality of Long-Term Care
Presented byJoshua M. Wiener, PhD, Marc Freiman, Ph.D., and David Brown, M.A.
RTI International
RTI International is a trade name of Research Triangle Institute
701 13th Street, NW ■ Suite 750 ■ Washington, DC 20005Phone 202-728-2094 e-mail [email protected] 202-728-2094
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Introduction
Concerns about quality for 30 years or longer
Quality of care and quality of life
Omnibus Budget Reconciliation Act of 1987
Some improvements, but poor quality care continues (IOM, GAO)
A lot known about nursing homes, very little about home care and residential care facilities
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Strategies for Improvement
Mandatory external pressure:Strengthen inspections and enforcementMany workforce initiatives (e.g., staffing ratios)
Voluntary external incentives:Provide information to consumersChange Medicare and Medicaid reimbursement
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Strategies (cont.)
Voluntary provider strategies:Change organizational culture
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Strengthen Inspections and Enforcement
Inspections are the main quality strategy of federal and state governments and other countries
Options include: Increasing funding for inspectionToughening enforcementTargeting poor facilitiesReducing predictability of surveyStrengthening federal oversight
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Inspections and Enforcement (cont.)
Inspections focus on structure and paperwork
Inconsistent application of rules
Rules may stifle innovation
Strict regulation may “poison” provider-state relations
Focus on minimum standards
Hard to make sanctions apply to management and not residents
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Strengthen Caregiver Workforce
LTC provided by people, not machines
Increase staffing in nursing homes:No staffing ratios in federal regulationsStudies find better quality with more staffingOpponents say management of staff is more
importantCosts could be high
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Strengthen Workforce (cont.)
Staff training: Increase training requirementsWhat is right level? Training on what?Who will pay?Will this exacerbate the staffing shortage?
Wages and benefits: Increase wages and provide fringe benefitsCosts would be significantLimited research on effect of wages on turnover
and quality
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Provide Consumers with More Information about Quality
Addresses market failure
Nursing Home and Home Health Compare, state Web sites
Little research on effectiveness
Can consumers interpret information?
Provider response?
Depends on imperfect regulatory data
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Change Medicare and Medicaid Reimbursement
75 percent of nursing home residents depend on Medicare and Medicaid, but responses to incentives are up to providers
Federal and state governments control level and type of reimbursement
Complex relationship between costs and quality
Pay-for-performance
Could cost more
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Change Organizational Culture
Eden, Wellspring, Pioneers, Green House
Regulatory barriers
Does greater medical need undercut rationale?
Do they require more staff?
Does it work?
Are effects the result of a charismatic leader?
What public policy levers?
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Conclusions
Know a lot about nursing homes, but not residential care and home care
Quality of care rather than quality of life
Shared federal-state responsibility
Regulation uneven across providers
Many options require additional resources
Existing research provides little guidance regarding relative effectiveness of different strategies