The Best Nursing Home Quality Measure CMS Does Not Publish – TurnoverMarch 3rd, 2014 by
A recent Journal of the American Medical Directors Association (JAMDA) article prompted this question: Are Nursing Home Survey Deficiencies Higher in Facilities With Greater Staff Turnover? (Published February 2014).
When you have to personally recommend a nursing home, how do you pick from the myriad of facilities in your region? Sad to say, I do not look at Nursing Home Compare or other widely available measures. I’ve worked in LTPAC since 1977 – sometimes it’s impossible to avoid becoming a surrogate decision maker for friends when someone they care for is facing Nursing Home Placement. (e.g. Where should I place my mother?) When I have to become a surrogate – here are the ‘quality issues’ I’ll focus on to make that recommendation. Of course, that is after filtering by selection factors such as personal finances and specialty needs:
1. What location will permit the highest number of actual family visits? Family and friends visiting is the best way to get quality care. Almost any facility will step-up their game if friends/family are involved (preferably daily – if just for 10-20 minutes). There are great facilities and terrible facilities, but the vast majority fall in the middle; they do a good job with limited resources. Patients with high frequency family involvement will get more care. If you make a mistake and pick the wrong location – you’ll know it first-hand. There is no substitute for direct observation.
2. Administrative Turnover: When visit frequency is not a variable based on facility location, I then look at turnover. Simply because of my role, I usually know how to find a facility’s Administrative Turnover. Of the available facilities, which has the most tenured leadership (administrator, Exec Dir, etc.)? Once they pass 5 years tenure, I stop counting. Stability at the top is the easiest way to correlate the relative quality of the organization.
Reading that JAMDA article was a comfort – seeing some scientific proof that turnover was directly linked to quality. Wonder when CMS will begin publishing this data; it’s in their files?