A new report has been completed by nursing home expert Charlene Harrington and her colleagues at the University of California, San Francisco, showing trends in U.S. nursing homes by state for 2005 through 2010. The data are from the federal On-Line Survey and Certification System (OSCAR) reports that are completed at the time of the annual nursing home surveys by state Licensing and Certification programs for the U.S. Centers for Medicare and Medicaid Services.
The average nursing home received almost 10 deficiencies for poor quality of care and almost one-fourth of nursing homes had deficiencies that caused actual harm or jeopardy to residents. Moreover, continued wide variations in staffing, residents, quality of care and deficiencies were found across states.
. The highlights of the new report for all US nursing homes show that:
Facility Characteristics
• In calendar year 2010, 15,622 nursing homes with 1.66 million beds were surveyed by state agencies.
• Of the 1.4 million residents in nursing homes, 63.4 percent had their care paid by Medicaid, 22.2 percent had care paid directly out of pocket or by private payers, and 14.4 percent of residents were paid by Medicare in 2010.
• The number of for-profit nursing homes increased from 66 percent of all homes in 2005 to 67.6 percent in 2010, while the number of non-profit nursing homes and public homes declined slightly. Nursing home chains were 54.7 percent of the total homes in 2010, showing a 4 percent increase over 2005.
Quality of Care
• Across the country, about 146,000 deficiencies were issued to nursing homes for violations of federal regulations in 2010, indicating many quality problems in the nation’s nursing homes.
• In 2010, 23 percent of the nation’s nursing facilities received deficiencies for poor quality of care that caused actual harm or jeopardy to residents.
• In 2010, 43 percent of nursing homes failed to provide adequate infection control and 43 percent failed to ensure a safe environment for residents to prevent accidents. Violations of food sanitation regulations were found in 39 percent of nursing homes and 34 percent received deficiencies for failure to meet quality standards.
• In 2010, 30 percent of nursing homes received deficiencies for failure to meet professional standards, 28 percent for failure to provide comprehensive care plans, 23 percent for giving unnecessary drugs, 21 percent for poor clinical records, 20 percent for failing to ensure resident dignity, 20 percent for poor housekeeping, and 19 for failure to prevent pressure sores.
Staffing
• The average number of registered nurse (RNs) hours per resident day increased by 18 percent between 2007 and 2010 (from 0.6 to 0.7 hours). The number of licensed practical nurses (LPNs/LVNs) increased by 14 percent and total nurse staffing increased by 5 percent between 2005 and 2010. The increase in staffing may be attributable to the rating of nurse staffing on the government’s Medicare Nursing Home Compare system introduced in 2008.
• Studies have shown facilities with more RN staffing have higher quality of care on average. The average staffing levels are below the level recommended by experts which is 0.75 RN hours per resident day and 4.1 total hours of nurse staffing per resident day.
Resident Characteristics
• Although the present of residents reported with pressure sores declined by 13 percent from 2005 to 2010, about 90,000 residents (6.5 percent) have pressure sores. Most pressure sores can be prevented with adequate nursing care.
