Nursing Home Quality: Better Care Through Better Staffing?

In November 2002, the Centers for Medicare and Medicaid Services (CMS) launched a nationwide initiative to improve nursing home quality by making information about the quality of care in individual nursing homes much more widely available. This was a welcome step toward giving consumers more information about the quality of nursing home care. Since a study by the Institute of Medicine more than 15 years ago found serious and widespread deficiencies in nursing home care, several major studies have confirmed continuing difficulties.

Medicaid pays almost half of the country’s nursing home bill (48 percent in 2000). As state budget woes trigger even tighter constraints on Medicaid spending, the potential for even greater problems is evident. Already, turnover rates for nursing home staff are disastrously high. With less money for nursing homes to spend on employees, lower wages and lack of continuing education may make it increasingly difficult to secure current staff and attract new people into the industry.

How important to quality are staff numbers, skill levels, morale and turnover? What can be done to staffing levels and training to improve overall quality? Who can best drive positive change in the long-term care workforce? How will new programs, like the CMS initiative, influence nursing home quality? What role will government play in maintaining quality standards and improving staffing ratios?

These questions and others were addressed at a December 9, 2002 briefing cosponsored by the Alliance for Health Reform and The Commonwealth Fund. Speakers were: Len Fishman, president and CEO of the Hebrew Rehabilitation Center for the Aged in Massachusetts and former head of the nonprofit nursing home industry trade association; Elma Holder, consumer advocate and founder of the National Citizen’s Coalition for Nursing Home Reform; Arvid Muller, senior research analyst from the Service Employees International Union’s Nursing Home Program; and Mary Ann Kehoe, executive director of Wellspring Innovative Solutions in Wisconsin. Ed Howard of the Alliance moderated the discussion.