Improving the quality of long-term care

8/26/2016 |

When it comes to nursing homes, the question isn’t if you or someone you love will require care in a nursing home. It’s when. According to the Centers for Medicare and Medicaid Services, about 70 percent of people over age 65 will need long-term care services at some point, and more than 40 percent will require around-the-clock care a nursing home provides.

“The quality of nursing home care is a persistent concern,” says Kathleen Abrahamson, assistant professor of nursing. “Nursing home residents are arguably the most complex of all patient populations as they tend to have chronic health conditions, cognitive impairment and functional loss, making their care exceedingly challenging.”

Abrahamson is co-investigator on two federally funded projects examining the effects of state policy on nursing home quality. She joined the Purdue faculty in fall 2013 after serving as assistant professor in the Department of Public Health at Western Kentucky University and has 10 years of professional nursing experience.

She says traditional approaches to addressing care quality in nursing homes have included regulatory sanctions for poor quality care or pay-for-performance models that base Medicaid payment on performance measures. However, neither of these top-down strategies has been particularly effective.

Dr. Abraham’s work suggests a better approach is when the state provides the resources for nursing homes to identify targeted areas for improvement and then providers initiate and implement quality improvement solutions. The Minnesota Performance-based Incentive Program (PIPP) is an example of this. Established in 2006, PIPP projects have addressed a wide range of quality issues such as falls, immobility, pain, skin care, quality of life and transitions between care settings.

“In this bottom-up approach, providers are incentivized to plan their own quality improvement projects and select the metrics that will measure if the intervention was successful,” Abrahamson says. “Our findings suggest that pay-for-performance projects not only help organizations build their capacity for quality improvement, but the value of these projects extends beyond the targeted area of improvement.”

Results were published in Health Affairs, September 2013; Journal of Gerontological Nursing, July 2013; and Annals of Long-Term Care: Clinical Care and Aging, July 2013.

One portion of the study focused on 13 facilities participating in a PIPP project to reduce falls, and specifically the nursing home employees’ perceptions of the quality improvement implementation process. Results support the importance of organizational flexibility and adaptation to change; communication and connections between residents, family members and staff; and the importance of input from diverse roles.

“It’s important to note that interview respondents observed changes that extended well beyond the domain of falls,” Abrahamson says. “Knowledge from this study highlights the experiences of care providers enacting change and potentially informs the development of management and program policies that encourage and reward quality nursing home care.”

Abrahamson’s research interests extend to quality of life issues for nursing home residents, the work environment of nursing home staff and the impact of functional impairment on long-term care service utilization.

One recent study examined the influence of nursing facility characteristics on resident quality of life and also the impact of cognitive impairment and residence on a dementia special care unit. Findings appeared in the June 2013 issue of the Journal of Aging and Health.

Abrahamson’s team found the level of a resident’s cognitive impairment was negatively related to quality of life, although residing on a dementia special care unit had a positive impact. Additionally, certified nursing assistant and activity personnel hours per resident day had a positive relationship with resident quality of life.

“Our results highlighted the need to ensure adequate levels of paraprofessional direct care staff and the availability of dementia-focused special care units, despite current constraints on long-term care funding,” she says.

Other projects are focused on reducing hospitalizations among nursing home residents and transitioning residents back into the community. Abrahamson, who earned both her master’s degree and doctorate in sociology at Purdue, collaborates with the Regenstrief Center for Healthcare Engineering and the Center on Aging and the Life Course.

“It’s wonderful to be back at Purdue,” she says. “There are so many opportunities for research and to work with graduate students and other faculty on high-impact, large-scale projects.”

From HHS Researchers Spotlight, http://bit.ly/2cwbvee