Quality of Skilled Nursing Continues to Improve says CMS Data

America’s nursing facilities have continued to improve in quality over the years, but quality measurement needs to shift to reflect the evolution of skilled nursing services, says a report from the Alliance for Quality Nursing Home Care and American Health Care Association (AHCA) that looked at data from the Centers for Medicare and Medicaid Services (CMS) and researchers’ expert analyses.

There were measurable improvements in nine out of 10 quality measures since 2009, the report found, including short-stay measures such as patient delirium and pain and pressure ulcers, as well as a vast majority of long-stay measures such as measurable improvements in activities of daily living, high-risk pressure ulcers, resident mobility, and pain.

Additionally, trends in facility health survey citations and facilities cited for substandard quality of care have declined since 2009, while 16 out of 29 quality indicators have improved since 2000.


“Throughout this year’s report, there is a strong focus on rehabilitative care in SNFs (skilled nursing facilities) and our expanded role as a provider of post-acute care services,” said Alan Rosenbloom, president of the Alliance, in a statement. “In our long-standing commitment to quality measurement, we recognize that measurement metrics must evolve to reflect the care provided and the patients served in nursing facilities nationwide, which requires addressing existing deficiencies in the quality measurement process and developing measures that adequately evaluate our performance, particularly in the areas of post-acute and rehabilitative care.”

Skilled nursing facilities are the largest provider of post-acute rehabilitative services in healthcare, and they’ve seen a dramatic shift in patients requiring short-term therapy services en route to returning to independent living, says the Alliance, as opposed to long-stay residents.

However, current quality measures more commonly reflect the traditional role of nursing homes, and don’t allow for proper measurement of rehabilitation services for short-stay Medicare patients, and this means there needs to be a change in the way nursing facility quality is measured, found the report’s contributors.


“Post-acute care has gravitated to a system of multiple transfers to different levels of care,” said Andrew Kramer, MD, in a statement. “With this evolution, it is critical that measures of rehabilitation quality follow patients across these transitions over fixed time intervals rather than during individual stays.”

The report includes recommendations for improving quality measurement and care processes, such as developing and endorsing more measures related to the care provided to short-stay nursing patients; strengthening the risk adjustment methodologies currently applied to the nursing facility measurement set; a paradigm shift in post-acute rehabilitation performance measurement that includes patient-reported function following rehabilitation discharge as patient function continues to change; and continued involvement in national quality improvement initiatives among all nursing facilities.

View the report here.

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Written by Alyssa Gerace