![]() High-performing NHs were less likely to have had more than 30 COVID-19 cases than were low-performing facilities across each domain (health inspections, 348 vs 948 quality measures, 897 vs 397 nurse staffing, 382 vs 907 ). Within each domain, 1451 (34.1%) were considered high performing for health inspection 2974 (70.1%) for quality measures and 1517 (35.9%) for nurse staffing ( Table 1). Of the 4254 NHs across the 8 states, 4254 (100%) had star ratings for health inspection 4241 (99.7%), quality measures and 4225 (99.3%), nurse staffing domains. Chan School of Public Health Institutional Review Board waived the need for informed consent. Two-sided P values were considered significant at the P < .05 level. The study was conducted using SAS version 9.4 (SAS Institute Inc). We performed 3 separate ordinal logistic regression models to assess the odds of high-performing facilities (4- or 5-star facilities) having more than 30 cases vs 11 to 30 cases vs 10 cases or fewer relative to low-performing facilities (1- to 3-star facilities), adjusting for the number of certified beds and including county fixed effects. Given how COVID-19 data are publicly reported across some states, we were limited to grouping NHs into 3 categories: those with 10 or fewer, 11 to 30, or more than 30 COVID-19 cases. The nurse staffing domain is based on the mean staffing hours per resident by qualified nursing staff. The quality measures rating is based on the weighted mean of performance across 15 quality measures (eg, avoidable hospitalizations, pressure ulcers, urinary tract infections). 2 The health inspection rating is based on the number of deficiencies identified in the 3 most recent state surveys across several areas, including staff-resident interactions and adequate infection control protocols. We linked these data with CMS Nursing Home Compare, which includes star ratings (range, 1 to 5 ) that characterize performance across the 3 domains. We used data from 8 state health departments (California, Connecticut, Florida, Illinois, Maryland, Massachusetts, New Jersey, and Pennsylvania) to determine the total number of COVID-19 cases occurring in NHs between January 1, 2020, and June 30, 2020. The incidence and death rates from Covid in 2020 demonstrate the validity of this description. ![]() In the best of times they overwhelmingly depend on low paid, unskilled, and often uncaring employees with high turnover. Deficiencies are enforced with fines and specific recommendations that are very focused, but over look management and ownership's attitudes.Įvery article discussing NH quality of care must contain a caveat that in this country we have a policy of warehousing our elderly out of sight generally in commercial facilities managed by companies not interested in patient care but in government-subsidized cash flow, real estate values, and REIT possibilities. Generally the inspections deal with the basic floor of quality rather than motivating competencies and caring. NH visits focus on policies and procedures, general considerations like cleanliness (the smell of urine), and reported functionalities (time sheets and patient check lists). Generally state oversight is underfunded and understaffed and it is not a particularly gratifying job. I spent a brief time as a NH inspector and again the system is better than nothing. Every physician who tends patients in a NH can tell you which are good and which are poor quality. I have tended patients in NH with similar "ratings" that range from crude, custodial-oriented care to careful, concerned attentive care. While better than nothing, the stars have only a tenuous relation to actual quality and caring within a facility. There is no "Joint Commission"-like oversight. ![]() NHs have every incentive to game them and upgrade themselves whenever possible. NH star ratings by CMMS are functionally crude, superficial and depend on check lists rather than actual observed function. Nonetheless, it mostly explores parameters that have only a tenuous relation to real world function: It does give some guidance for future improvement using a few objective parameters, e.g. This is an important and well conceived study. ![]() Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. ![]() Challenges in Clinical Electrocardiography. ![]()
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