longterm care Assigmt2

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Nursing Home Services: a Comparative Analysis of Services Offered by Skilled Nursing

Facilities using CMS data

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Abstract

The quick advances in medical services in the USA have increased the demand for nursing home

services. Despite nursing homes being under high scrutiny and regulations, their quality of

services is still a concern to many of their clients. Several studies indicate differences in the

quality of services provided by nursing homes. The purpose of the study was to investigate,

analyze and compare the differences in services provided by Traymore Nursing Center and other

nursing homes, particularly Covenant Living of Golden Valley Care & Rehab Ctr and Park

Pointe Healthcare & Rehab, using data provided by the Centers for Medicare and Medicaid

Services as indicated on their Nursing Home Compare web site.

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Introduction

Centers for Medicare and Medicaid Services reports indicate several concerns related to

Skilled Nursing facilities (Yoon et al, 2022). The problems vary from facility to facility, with

some facilities having commendable services and some having supposedly poor services. This

report proposes to shed light on the differences in the quality of services provided by some

Skilled Nursing Homes. The study on which this report is based was conducted to find the

differences between services provided by Traymore Nursing Centre and two other Skilled

Nursing facilities- Park Pointe Healthcare & Rehab and Covenant Living of Golden Care &

Rehab Ctr. The study focused more on the differences related to deficiencies in the provision of

services to residents in the respective facilities.

Materials

The study relied much on the information provided on the Nursing Home Compare website.

The report contains ratings and other values representing the aspects of health care the study

intended to investigate. The data on the website is generated by an independent agency, the

Centers for Medicare and Medicaid, assuring the credibility and authenticity of the data.

Methods

The technique applied entailed getting the differences in the ratings or values of aspects

directly indicating the quality of services in skilled nursing facilities. The difference in overall

rating, health inspection, quality measures, and staffing was observed from the number of stars

each facility rated for each of the mentioned aspects. The difference in elements such as the

number of certified beds, total number of health citations, the number of nurse staff hours per

resident per day, physical therapist staff hours per resident per day, and staffing turnover was

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obtained by subtracting the values of similar aspects. Moreover, the deficiencies indicated by the

differences in values were also compared to the national-wide values for better understanding.

Results

Table 1.1 indicates the results obtained from the CMS comparison website for the three

skilled nursing facilities covered by the study.

The aspect of

health care

service

Description Traymore

Nursing Center

Park Pointe

Healthcare &

Rehab

Covenant Living

of Golden Valley

Care & Rehab

Overall rating The more the

stars, the better

One star-Much

below average

One star-much

below average

Five stars- much

above average

Health

Inspection

The more the

stars, the better

Two stars- below

average

Three stars-

average

Four stars- above

average

Staffing The more the

stars, the better

1 star- much

below average

1 star- much

below average

Four stars- above

average

Quality

measures

The more the

stars, the better

Three stars-

average

1 star- much

below average

Five stars- much

above average

Total number

of health

citations

The lower, the

better

17 9 5

Number of The lower, the 12 3 0

5

complaints in

the past three

years that

resulted in a

citation

better

Total number

of nurse staff

hours per

resident per

day

The higher, the

better

3 hours 24

minutes

2 hours 28

minutes

5 hours 32

minutes

Physical

therapist staff

hours per

resident per

day

The higher, the

better

3 minutes 4 minutes 15 minutes

Registered

nurse hours

per resident

per day

The higher the

number, the

better

19 minutes 28 minutes 1 hour 44

minutes

Table 1.1

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Discussion

Worldwide there have been endeavors to promote health care quality worldwide. In the

United States, the desire to improve the quality of care led to the emergence of a concept

abbreviated as QAPI (Quality Assurance and Performance Improvement) (Geng et al, 2019). The

double-pronged aspect assumes a comprehensive, systematic, and data-driven approach to

improving and maintaining standard quality care in nursing homes.

Standard quality care entails several considerations outlined by the Federal Regulatory

Groups for Long-term Care, commonly referred to as F- tags. The overall rating of Traymore

Nursing Centre with one still indicates more F-tag deficiencies in the facility compared to the

other two facilities mentioned in this report.

The high number of complaints in Traymore Nursing Centre indicates deficiencies in

upholding freedom from abuse, neglect, and exploitation, poor food and nutrition services, or

undesirable quality of life at the facility. On the other hand, Covenant Living of Golden Valley

Care & Rehab has had zero complaints in the last three years. The absence of protests in the later

facility could mean the absence or presence of minor deficiencies of particular F-Tags.

According to the Centers for Medicare and Medicaid Services report (Form CMC- 2567,

02/99), many residents are affected by poor food and nutritional services at the Traymore

Nursing Centre. The undesirable food and dietary services could contribute to the lower rating

(much below average) of the facility's staffing compared to others like Covenant Living of

Golden Valley Care & Rehab, which has a rating above average.

The Nursing Home Care Compare website data generated from the Centers for Medicare

and Medicaid Services report also indicate a much-below-average rating for the Traymore

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facility in staffing. The rating is similar to Park Pointe Healthcare & Rehab's, but it is surpassed

by Covenant Living of Golden Valley Care & Rehab's, which is much above average. This lower

staffing rating for the former facility is consistent with its relatively lower values of registered

nurse hours per resident per day and physical therapist staff hours per resident per day. Besides

personnel hours per resident per day, the lower rating of the facility's staffing could also be

caused by poor interpersonal relationships between the staff and residents.

The rating for quality measures in the Traymore facility is above average, whereas the Park

& Pointe facility has a rating of much-below standard for the same aspect. On the far end,

Covenant Living Facility was much above average. The rating for the Traymore facility, in

particular, is consistent with the few cases of residents affected by the poor quality of life at the

facility as reported by the Centers for Medicare and Medicaid Services (Form CMS- 2567,

02/99).

Conclusion

In summary, the Traymore Nursing Centre has many deficiencies in standard quality care,

as evidenced by the lower ratings in reports derived from the Centers for Medicare and Medicaid

Services. Generally, these ratings are close to those of some facilities like Park & Pointe

Healthcare & Rehab. Still, they are far less than the ratings of other facilities like Covenant

Living of Golden Valley Care & Rehab. Such deficiencies in the standard indicate the presence

of challenges in the standardization of care. The challenges cement the need for more regulations

and oversight of services provided by nursing homes (Wesson et al, 2021). The persistence of

these challenges, amidst the advances and the increased demand for Nursing Home services

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further, makes the problems more complex ( Hansen et al, 2019). Additionally, the rising

numbers of Skilled Nursing Facilities also contribute to the difficulty of regulating nursing home

services. Such complexities call for newer, refined models and policies to adequately handle and

control nursing home services.

Recommendations

A diverse set of deficiencies in nursing homes calls for a multidimensional approach to

control the problems, especially for institutions whose performance is rated below average

(Wesson et al, 2021). In addition, the administrators of nursing homes should be aware that non-

compliance with a single F-Tag typically creates a chain of events that leads to defaults in other

F-Tags. The management of nursing homes should therefore prepare their respective institutions

to detect and act promptly in cases of deficiencies. In events where insolvencies can be

anticipated, institutions should be ready to work proactively rather than waiting for the foreseen

deficits of care.

Nursing homes like Traymore Nursing Centre with issues concerning food and nutrition

approaches like training cooks should be considered. However, the institution should initially

find out if the deficiency arises from multiple points or a single option, such as proper training of

cooks. Other approaches can include advising nutritionists in meal planning, allowing residents

to choose alternative meals, and having a written policy for food and nutrition in the institution.

Where residents are subjected to unlawful acts such as abuse, neglect, or exploitation, a

permanent committee should be formed to investigate such complaints. In addition,

administrators should work with other stakeholders to develop written policies on handling abuse

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and exploitation claims. However, the best method is teaching employees how to relate with

residents and maintain positive interpersonal relations.

Finally, to improve the quality of life at nursing homes, facilities there should be much

attention to all activities that promote residents' self-esteem. Managers should strengthen the

social workers' capacity to serve all residents sufficiently. Moreover, awareness of the need to

treat residents with dignity should be a priority n all nursing homes. The management of nursing

homes should also keep employees motivated to boost their capacity to deliver services to

residents (Bui et al, 2020). These are few criteria among the other potential measures that

administrators can consider to raising and maintaining the standards of quality care.

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References

Bui, D. P., See, I., Hesse, E. M., Varela, K., Harvey, R. R., August, E. M., ... & Atkins, A. (2020).

Association between CMS quality ratings and COVID-19 outbreaks in nursing homes—

West Virginia, March 17–June 11, 2020. Morbidity and Mortality Weekly Report, 69(37),

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Geng, F., Stevenson, D. G., & Grabowski, D. C. (2019). Daily nursing home staffing levels highly

variable, often below CMS expectations. Health Affairs, 38(7), 1095-1100.

Hansen, K. E., Hyer, K., Holup, A. A., Smith, K. M., & Small, B. J. (2019). Analyses of complaints,

investigations of allegations, and deficiency citations in United States nursing

homes. Medical Care Research and Review, 76(6), 736-757.

Wesson, K. W., Donohoe, K. L., & Patterson, J. A. (2021). CMS Mega-Rule Update and the Status

of Pharmacy-Related Deficiencies in Nursing Homes. Journal of Applied

Gerontology, 40(11), 1617-1627.

Yoon, J. M., Trinkoff, A. M., Galik, E., Storr, C. L., Lerner, N. B., Brandt, N., & Zhu, S. (2022).

Nurse staffing and deficiency of care for inappropriate psychotropic medication use in

nursing home residents with dementia. Journal of Nursing Scholarship.