The American Health Care Association (AHCA), Washington, and the Alliance for Quality Nursing Home Care (Alliance), Washington, have released the nursing, post-acute, short-term, and rehabilitative sector’s first comprehensive report examining quality trends in the nation’s nursing homes, highlighting the positive evolution of skilled nursing and rehabilitation facilities along with the subsequent benefit to cost-effective seniors’ care; consumer and workforce satisfaction; and other key, quantifiable measures of quality, including public policy recommendations for moving quality forward, says a statement released by AHCA.

AHCA and the Alliance note that this is the first independent report that sets a framework for evaluating quality and provides recommendations for policy changes that will make quality metrics more reliable and that improvements in quality, as highlighted in the report, could not be achieved without a stable economic environment, an important relationship essential to maintaining these positive trends.

The organizations have urged Congress to recognize the quality improvements that have been achieved in recent years and to understand the crucial role stable Medicare financing plays in ensuring continued enhancements to quality of care and quality of life for millions of seniors being cared for in America’s nursing and rehabilitation facilities.

In releasing the report, Bruce Yarwood, president and CEO of AHCA, and Alan Rosenbloom, president of the Alliance, noted that in 2002, the organizations joined forces to make a national, public pledge to improve quality care for long-term care patients and residents. This initiative, known as Quality First, also promised to promote a progressive workplace for long-term care employees, to advance the development of key quality measures, and to publicly and transparently report the results of quality performance, says the statement.

The report relies primarily on independent findings from researchers and research organizations in long-term and post-acute care, such as Avalere Health; Vincent Mor, PhD, professor and chair of the Department of Community Health at the Brown University School of Medicine and former director of the Brown University Center for Gerontology and Health Care Research; Steven Littlehale, senior researcher of PointRight; My InnerView results; and analyses of publicly available government data.

Some of the key findings from the independent assessments included the following:

* There appears to be a relationship between adequate reimbursement and quality improvements, access to quality care.
* Nursing and rehabilitation facilities have evolved to meet the special demands and needs of an aging population. There is a much greater focus on post-acute care, and the length of stay of most patients is now less than 90 days.
* Quality has improved in many areas, though work remains. Measurable improvements can be seen in the decline in use of physical restraint, decline in amount of pressure ulcers, improvements in key clinical areas such as weight loss, dehydration, and levels of patient activity and pain management.
*Existing metrics don’t reflect the different patient populations in nursing and rehabilitation facilities currently or the increasing specialization that is resulting from these different patient populations.
* Patient satisfaction levels are high. Eighty-five percent of consumers rated their overall satisfaction and their recommendation for the facility to others as either “excellent” or “good” – up 3% from 2007 to 2008.

“Our goal in preparing this report is to provide an objective and representative overview of the state of nursing and rehabilitative care in America by highlighting key quality trends, improvements, and areas that require more attention in the future,” said Yarwood in the statement. “Many challenges we face as a sector are directly related to the dramatic transformation that our nation’s nursing and rehabilitation facilities have undergone in recent years to meet the changing care needs of the people we serve and the modernization of long-term care delivery. At the same time, we acknowledge there is still much room for improvement, and these areas are detailed in the report so that providers, consumers, and policymakers can work together to chart a course for continuing improvement now and into the future.”

Said Rosenbloom, “In reviewing the report findings, there is ample evidence that initiatives such as Quality First have improved quality of care and quality of life for our residents and patients in several key clinical areas. Evidence is mounting on the cost effectiveness of our services as compared with other sites of service—especially for patients requiring intensive rehabilitative and medically complex care. Because facilities devote a full 70% of operating expenses to wages, benefits, and other labor costs, Medicare funding stability from Washington is essential to the ongoing, successful operation of our quality improvement programs.”

Other data in the report show increases in patient, family, and caregiver satisfaction. Conversely, residents, their families, and staff also identify areas that merit improvement—such as the need for greater choice, better communication from management, and more relief from substantial job stress in the workplace.

The Quality Report also adds detailed context to the ongoing debate surrounding the transformation of the nation’s long-term care system—and the fact that the common perception of a “nursing home” is outdated. In reality, the report details, the nursing home of the 21st century is more accurately described as a “nursing and rehabilitation facility” where nearly half of the people admitted are able to return home after a stay of approximately 1 month.

The 2009 Annual Quality Report is available in its totality at and

AHCA is a nonprofit federation of affiliated state health organizations, together representing more than 10,000 nonprofit and for-profit assisted living, nursing facility, developmentally-disabled, and subacute care providers that care for more than 1.5 million elderly and disabled individuals nationally.

The Alliance is a coalition of 16 national, long-term care provider organizations that care for approximately 300,000 elderly and disabled patients each year in nearly 1,800 facilities across America.

[Source: AHCA]