Skilled Nursing Providers Answer Call to Improve Care Quality

Skilled nursing facilities (SNF), like hospitals, have recently been subject to federal scrutiny for avoidable hospital readmissions, and new reports and data show that quality improvements are taking hold.

The 30-day re-hospitalization rate for post-acute skilled nursing patients showed significant decline from 21.6% in FY 2007 to 20.9% in FY 2011, according to new analysis from the the Alliance for Quality Nursing Home Care.

Detailing quality of care trends in SNFs nationwide, the Alliance’s report takes into account specific indicators and conditions that could make certain patients susceptible to hospitalization. 


Between 2003 and 2010, SNFs showed improvement in eight chronic care measures related to pain, high-risk pressure ulcers, catheters, restraints, activities of daily living decline, weight loss, depression and pneumonia vaccination. 

An increase in the average number of hours worked by nurse aides and licensed nurses were also found to contribute to improved quality outcomes as the percentage of contract staff decreased from 2003 to 2011. 

“Incorporating other metrics into this evaluation of SNFs—such as survey outcomes and staffing—offers a better look into quality,” said Steven Littlehale, chief clinical officer of PointRight, a national long-term care analytics firm that prepared the report analysis.


Measuring quality of care progress is essential not only for providers of long-term care, but for the nation as a whole, according to Alan G. Rosenbloom, president of the Alliance.

“Consumers, lawmakers and facilities themselves need to know where quality is improving, where performance has reached a plateau, and where quality challenges persist,” said Rosebloom.

While there have been real and continuing successes, says Rosenbloom, improvement must continue to be a significant focus for the skilled nursing sector as well as collaborating stakeholders.

The American Health Care Association (AHCA) has made significant headway in improving skilled nursing quality outcomes for many of its members since announcing its Quality Initiative in February 2012. 

In 2012, AHCA members were able to reduce the use of off-label anti-psychotic drug use by 6.7% in skilled nursing facilities, according to Neil Pruitt, Jr., AHCA board chair during a conference call Monday.

Additionally, 38.3% of AHCA members were able to achieve a 15% reduction in the use of anti-psychotic medications in skilled nursing facilities. 

The 6.7% antipsychotic reduction rate combined with the 38.3% of AHCA members who achieved higher-than-average readmission reductions led to a better total reduction rate for AHCA members compared to the national average of 5.9% in 2012. 

Much of this effort, said Pruitt, included engaging consultant pharmacists, nursing staffs as well as educating administrators and behavioral health coordinators about the impacts these off-label drugs pose for elderly residents.

“We are quite pleased with the 6.7% reduction in anti-psychotic drug use in the last four quarters,” said Dr. David Gifford, AHCA senior vice president of Quality & Regulatory Affairs. “With 11,350 fewer people taking these medications, there has been great benefits to individual outcomes.”

Similar to the Alliance, AHCA—some of whose members overlap—is also encouraging its members to reduce hospital readmissions.

Analyzing data through a risk-adjusted re-hospitalization measure, 25% of AHCA members have been already been able to achieve the three-year goal of a 15% reduction rate. 

These reductions in 30-day hospital readmissions have equated to about 14,000 individuals, in turn saving Medicare approximately $140 million, according to AHCA’s findings.  

Ensuring there is communication between skilled nursing staff and doctors, as well as identifying early warning signs that might make a patient susceptible to readmission helped AHCA achieve its results, said Pruitt. 

While AHCA’s conference call only discussed results of two aspects of the trade group’s Quality Initiative to limit off-label medication use, reduce hospital readmissions, increase staff satiability and consumer satisfactions, the agency remains hopeful for future outcomes. 

“Bringing the best practices is what this initiative has been about,” said Pruitt. “We are very pleased with the progress AHCA has made in addressing these initiatives.”

Written by Jason Oliva

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