WASHINGTON — There is no question that all long-term care stakeholders regard industry-wide quality as a priority. Yet, there have been many disagreements and disconnects over the years when it comes to defining quality, how to make it happen, and how to share successful practices. The pressure to fill beds, shrinking funds, stagnant reimbursements, staffing shortages, regulatory oversight, and negative news stories have led to finger-pointing and competition. Instead of cooperation, the result has been fear-driven behaviors and breakdowns in communication. Instead of working as a team, providers, practitioners, policy makers, consumers, and others often have found themselves working in isolation. Last month, a group of stakeholders gathered to reopen the lines of communication and join their resources to make a commitment to excellence in America's nursing homes. AMDA leaders—among nearly 500 long-term care providers, caregivers, medical and quality improvement experts, government officials, and consumers—gathered at a Quality Summit to kick off a national “Advancing Excellence in America's Nursing Homes” campaign. This initiative is aimed at strengthening the public trust in nursing home care by focusing on quality improvement and transparent accountability. The campaign also acknowledges the role of nursing home staff and will look at best practices for improving staff recruitment and retention. It is difficult to pinpoint when the communication gaps in long-term care began. However, the advent of the Prospective Payment System in the early 1990s is one event that divided the nursing home reimbursement pie and led various disciplines and specialties to vie for a share. At the same time, the growing elderly population in this country and expanding continuum of care led to increased competition among long-term care facilities for residents. As some incidents of poor quality gained attention in national news, consumers began to trust the long-term care industry less and less. Meanwhile, quality efforts became more proprietary than universal. Keith Krein, M.D., CMD, chief medical officer and senior vice president at Kindred Healthcare, explained that the evolution of long-term care has created a situation in which communication and cooperation between settings and individuals often are lost. “Today's nursing centers have evolved into health care centers caring for individuals with illness burdens [who] just a few decades ago would have received the bulk of their care in hospitals,” he noted. “Today, during a similar 4- to 6-week period of illness, patients may be shuffled through multiple service sites, each focusing on differing priorities, using different data tools and outcome measures, and employing different cost structures and reimbursement limitations. Consumers usually are left confused and bewildered because what they adapted to in one setting is now different in the next.” The same can be said for many health care professionals who have to deal with multiple care sites, varying regulations and policies, and different formularies, he said. The presence of government leaders such as former Sen. Bob Kerrey (D-Neb.) and Centers for Medicare and Medicaid Services representatives demonstrated policy makers' commitment to work with the long-term care industry in its efforts to maximize quality. Former CMS Administrator Mark McClellan said, “The groups represented here don't agree on everything, but we agree” on this initiative. He said, “We are working toward a future of long-term care based on choice and quality of care and developing a time line for implementing specific steps for reform.” Industry representatives echoed Dr. McClellan's enthusiasm and emphasized a commitment to improving teamwork and communication. Dr. McClellan said “various sectors often have been adversaries and not team players,” but “care is a shared responsibility in every community.” He also noted that American citizens have a right to “moral, ethical nursing home care and nothing less.” The “Advancing Excellence” campaign asks providers to voluntarily commit to tracking their progress on at least three of eight measurable quality goals. Four of the goals—including reducing physical restraint use and reducing pain for both long- and short-stay residents—focus on clinical outcomes for those receiving care in nursing homes. The other goals address process-related organizational culture objectives such as resident/family expectations of care and staff turnover. Regular campaign updates showing progress in the aggregate will be posted on the campaign Web site at www.nhqualitycampaign.org. This is the same site at which facilities and others can sign up to participate in the campaign. Additionally, the site will list the nursing homes participating in the campaign to allow consumers, providers, and organizations such as national and state associations to track which homes have enrolled. AMDA members and other physicians have an important role to play in the campaign, suggested association president Steve Levenson, M.D., CMD. As he explained, “If you address one or two issues successfully, the success will spread to other areas. Using and applying proven methods and principles and evidence-based medicine is something we all can and should be doing every day.”
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