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The Nursing Facility Quality Measurement Subcommittee of the Unified Long-term Care System Advisory Workgroup recommended 20 accountability measures for determining how well facilities take care of their residents. The full report and the recommendations are available online.
The 15-member subcommittee was made up of advocates for the elderly, representatives of nursing homes, state officials and legislators. The measures they developed include allowing residents to choose when they go to sleep and get up in the morning, and giving them the opportunity to take a bath or shower whenever they like. In addition to encouraging person-centered care, the measures also seek to reduce bedsores and urinary-tract infections, limit turnover of staff members and improve family satisfaction.
"Governor Kasich has made it clear from the time he started campaigning that Ohio's elders and those with disabilities and who need assistance should be able to live with dignity and respect in settings they prefer as their care needs change," said Bonnie Kantor-Burman, director of the Ohio Department of Aging and a member of the advisory workgroup. "These quality incentive measurements will help Ohio's nursing facilities improve the health of their residents, while giving them more choices and control over their lives."
In addition to being relatively inexpensive to implement and shown to yield benefits for residents, nursing home staff or both, the recommended measures also are:
For each quality measure, the subcommittee provided a definition, method of calculation, source of data and the threshold a facility must meet to earn a point for the purposes of calculating the facility's quality incentive payment. Achievable thresholds were developed based on available data.
The subcommittee also identified sources for technical assistance, including the Office of the State Long-term Care Ombudsman, that can help nursing facilities achieve full quality incentive payments.
"Long-term care ombudsmen throughout Ohio are enthusiastic about the momentum these recommendations create. Residents should be home wherever they live, and the quality improvements envisioned are the steps nursing homes need to take," said Beverley Laubert, the State of Ohio Long-term Care Ombudsman. "Ombudsmen will partner with state agencies, the Ohio Person-Centered Care Coalition and Ohio KePro to make sure nursing homes have access to technical assistance and resources they need."
The subcommittee developed a method for calculating quality incentive payments and a bonus system to redistribute any unspent payments. The goal is to create a system that rewards performance on specific quality measures and gives all facilities a fair opportunity to earn the full payment. A facility will earn one point for each performance measure threshold it meets. A facility must earn five points to receive the full quality payment of $16.44 per Medicaid bed day in 2013. Facilities with less than five points receive one-fifth of the full quality payment per point. The budget assumes that every nursing facility will receive the full quality incentive payment. If some facilities do not achieve five points and there is funding left at the end of the fiscal year, then that amount will be distributed to facilities that earned more than five points based on each facility's Medicaid bed days and total points received.
Pete Van Runkle, executive director of the Ohio Health Care Association, told the Columbus Dispatch that quality incentives will "be very helpful in getting (nursing homes) focused on these issues." He predicted that most of the more than 900 nursing homes in Ohio will meet the five goals needed to qualify for bonus payments, but some goals will take time.
The Ohio General Assembly is now reviewing the recommendations and may use them to amend the Budget bill as appropriate by Dec. 31, 2011. If accepted, the new reimbursement incentives would go into effect July 1, 2012.
The Nursing Facility Capacity Subcommittee of the Unified Long-term Care System Advisory Workgroup also submitted its report to the legislature on Sept. 1. The subcommittee studied the ability of nursing facility operators to determine the number of beds to certify for participation in the Medicaid program. Provider associations, such as Ohio Health Care Association and LeadingAge, described the need to give nursing facilities the ability to transfer a resident among units and align the services provided with the resident's needs as those needs change (e.g., from a rehab unit to a long-term care unit). State agency staff proposed that the objective could be met through administrative rule change, rather than changing state Medicaid certification laws. The subcommittee recommended revised rule changes to the Joint Committee on Agency Rule Review.
Aging Connection, published regularly by the Ohio Department of Aging, connects professionals in Ohio’s aging network to information and resources that can help them care for and serve our older citizens. Topics include the latest resources and best pactices within the aging network, state and federal programs and benefits, pending and recent policy and legislation that may impact older Ohioans, the latest research in gerontology and aging issues and more.
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