Nursing Homes: Sustained Efforts Are Essential to Realize Potential of the Quality Initiatives

Nursing Homes: Sustained Efforts Are Essential to Realize Potential of the Quality Initiatives

Date: September 28, 2000
Creator: United States. General Accounting Office.
Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on federal and state initiatives to improve the quality of nursing homes, focusing on: (1) progress in improving the detection of quality problems and changes in measured nursing home quality; (2) the status of efforts to strengthen states' complaint investigation processes and federal enforcement policies; and (3) additional steps taken at the federal level to improve oversight of states' quality assurance activities."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Despite Increased Oversight, Challenges Remain in Ensuring High-Quality Care and Resident Safety

Nursing Homes: Despite Increased Oversight, Challenges Remain in Ensuring High-Quality Care and Resident Safety

Date: December 28, 2005
Creator: United States. Government Accountability Office.
Description: A letter report issued by the Government Accountability Office with an abstract that begins "Since 1998, GAO has issued numerous reports on nursing home quality and safety that identified significant weaknesses in federal and state oversight. Under contract with the Centers for Medicare & Medicaid Services (CMS), states conduct annual nursing home inspections, known as surveys, to assess compliance with federal quality and safety requirements. States also investigate complaints filed by family members or others in between annual surveys. When state surveys find serious deficiencies, CMS may impose sanctions to encourage compliance with federal requirements. GAO was asked to assess CMS's progress since 1998 in addressing oversight weaknesses. GAO (1) reviewed the trends in nursing home quality from 1999 through January 2005, (2) evaluated the extent to which CMS's initiatives have addressed survey and oversight problems identified by GAO and CMS, and (3) identified key challenges to continued progress in ensuring resident health and safety. GAO reviewed federal data on the results of state nursing home surveys and federal surveys assessing state performance; conducted additional analyses in five states with large numbers of nursing homes; reviewed the status of its prior recommendations; and identified key workforce and workload issues confronting ...
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: More Can Be Done to Protect Residents from Abuse

Nursing Homes: More Can Be Done to Protect Residents from Abuse

Date: March 1, 2002
Creator: United States. General Accounting Office.
Description: A letter report issued by the General Accounting Office with an abstract that begins "Often suffering from multiple physical and mental impairments, the 1.5 million elderly and disabled Americans living in nursing homes are a highly vulnerable population. These individuals typically require extensive help with daily living, such as such as dressing, feeding, and bathing. Many require skilled nursing or rehabilitative care. In recent years, reports of inadequate care, including malnutrition, dehydration, and other forms of neglect, have led to mounting scrutiny from state and federal authorities, which share responsibility for overseeing the nation's 17,000 nursing homes. Concerns have also been growing that some residents are abused--pushed, slapped, or beaten--by the very individuals to whom their care has been entrusted. GAO found that allegations of physical and sexual abuse of nursing home residents are not reported promptly. Local law enforcement officials said that they are seldom summoned to nursing homes to immediately investigate allegations of abuse and that few allegations are ever prosecuted. Some agencies use different policies when deciding whether to refer allegations of abuse to law enforcement. As a result, law enforcement agencies were never told of some incidents or were notified only after lengthy delays. GAO found ...
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents

Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents

Date: March 26, 2007
Creator: United States. Government Accountability Office.
Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 1998 and 1999 reports, GAO concluded that enforcement actions, known as sanctions, were ineffective in encouraging nursing homes to maintain compliance with federal quality requirements: sanctions were often rescinded before being implemented because homes had a grace period to correct deficiencies. In response, the Centers for Medicare & Medicaid Services (CMS) began requiring immediate sanctions for homes that repeatedly harmed residents. Using CMS enforcement and deficiency data, GAO (1) analyzed federal sanctions from fiscal years 2000 through 2005 against 63 homes previously reviewed and (2) assessed CMS's overall management of enforcement. The 63 homes had a history of harming residents and were located in 4 states that account for about 22 percent of homes nationwide."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Complaint Investigation Processes in Maryland

Nursing Homes: Complaint Investigation Processes in Maryland

Date: June 15, 1999
Creator: United States. General Accounting Office.
Description: Testimony issued by the General Accounting Office with an abstract that begins "GAO discussed its recent findings on the effectiveness of federal and state nursing home complaint investigation processes, with a specific focus on its work in Maryland."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: CMS Needs Milestones and Timelines to Ensure Goals for the Five-Star Quality Rating System Are Met

Nursing Homes: CMS Needs Milestones and Timelines to Ensure Goals for the Five-Star Quality Rating System Are Met

Date: March 23, 2012
Creator: United States. Government Accountability Office.
Description: A letter report issued by the Government Accountability Office with an abstract that begins "CMS developed and implemented the Five-Star System largely during an 8-month period in 2008 with input from long-term care stakeholders, CMS’s Five-Star System contractor, and members of a technical expert panel—a panel composed of nine individuals that CMS identified as experts in long-term care research. CMS made numerous methodological decisions during the development of the Five-Star System, including three key methodological decisions. GAO defines key methodological decisions as those that at least six technical expert panel members—of the nine that GAO contacted—recalled as eliciting the most intense review and discussion during the development of the Five-Star System. One key methodological decision was how to combine the component ratings to create an overall rating. The other two key methodological decisions pertained to how to create ratings that account for variation in the type of care provided across nursing homes."
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Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Quality Standards

Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Quality Standards

Date: March 18, 1999
Creator: United States. General Accounting Office.
Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the enforcement of federal nursing home standards, focusing on: (1) national data on the existence of serious deficiencies in nursing home compliance with Medicare and Medicaid standards; and (2) the use of sanction authority for homes that failed to maintain compliance with the standards."
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Nursing Homes: Proposal To Enhance Oversight of Poorly Performing Homes Has Merit

Nursing Homes: Proposal To Enhance Oversight of Poorly Performing Homes Has Merit

Date: June 30, 1999
Creator: United States. General Accounting Office.
Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) proposal to expand the definition of "poor performing" nursing homes to include homes with repeated actual harm violations (G-level deficiencies)."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Complaint Investigation Processes Often Inadequate to Protect Residents

Nursing Homes: Complaint Investigation Processes Often Inadequate to Protect Residents

Date: March 22, 1999
Creator: United States. General Accounting Office.
Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on how states implement the federal requirement that establishes a process for nursing home complaint investigations, focusing on the: (1) effectiveness of state complaint investigation practices as a component of the system to ensure sustained compliance with federal nursing home quality-of-care standards; and (2) Health Care Financing Administration's (HCFA) role in establishing standards and conducting oversight of states' complaint investigation practices and in using information about the results of complaint investigations to ensure compliance with nursing home standards."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Public Reporting of Quality Indicators Has Merit, but National Implementation Is Premature

Nursing Homes: Public Reporting of Quality Indicators Has Merit, but National Implementation Is Premature

Date: October 31, 2002
Creator: United States. General Accounting Office.
Description: A letter report issued by the General Accounting Office with an abstract that begins "GAO was asked to review the Centers for Medicare & Medicaid Services (CMS) initiative to publicly report additional information on its "Nursing Home Compare" Web site intended to help consumers choose a nursing home. GAO examined CMS's development of the new nursing home quality indicators and efforts to verify the underlying data used to calculate them. GAO also reviewed the assistance CMS offered the public in interpreting and comparing indicators available in its six-state pilot program, launched in April 2002, and its own evaluation of the pilot. The new indicators are scheduled to be used nationally beginning in November 2002."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses

Nursing Homes: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses

Date: May 9, 2008
Creator: United States. Government Accountability Office.
Description: A letter report issued by the Government Accountability Office with an abstract that begins "GAO reports since 1998 have demonstrated that state surveyors, who evaluate the quality of nursing home care on behalf of CMS, sometimes understate the extent of serious care problems in homes because they miss deficiencies. CMS oversees the effectiveness of state surveys through the federal monitoring survey program. In this program, federal surveyors in CMS's regional offices either independently evaluate state surveys by resurveying a home (comparative surveys) or directly observe state surveyors during a routine nursing home survey (observational surveys). GAO was asked to evaluate the information federal monitoring surveys provide on understatement and the effectiveness of CMS management and oversight of the survey program. To do this, GAO analyzed the results of federal monitoring surveys for fiscal years 2002 through 2007, reviewed CMS guidance for the survey program, and interviewed headquarters and regional office officials."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Federal Efforts to Monitor Resident Assessment Data Should Complement State Activities

Nursing Homes: Federal Efforts to Monitor Resident Assessment Data Should Complement State Activities

Date: February 15, 2002
Creator: United States. General Accounting Office.
Description: A letter report issued by the General Accounting Office with an abstract that begins "Nursing homes that participate in Medicare and Medicaid must periodically assess the needs of residents in order to develop an appropriate plan of care. Such resident assessments are known as the minimum data set (MDS). According to officials in the 10 states with MDS accuracy review programs in operation as of January 2001, these programs were established to set Medicaid payments and identify quality of care problems. Nine of the 10 states conduct periodic on-site reviews in all or a significant portion of their nursing homes to assess the accuracy of the MDS data. These reviews sample a home's MDS assessments to determine whether the basis for the assessments is adequately documented in residents' medical records. These reviews often include interviews of nursing home personnel familiar with residents and observations of the residents themselves. States with separate MDS review programs identified various approaches to improve MDS accuracy. State officials highlighted the on-site review process itself and provider education activities as their primary approaches. State officials also reported such remedies as requiring nursing homes to prepare a corrective action plan or imposing financial penalties on nursing homes ...
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: CMS's Special Focus Facility Methodology Should Better Target the Most Poorly Performing Homes, Which Tended to Be Chain Affiliated and For-Profit

Nursing Homes: CMS's Special Focus Facility Methodology Should Better Target the Most Poorly Performing Homes, Which Tended to Be Chain Affiliated and For-Profit

Date: August 28, 2009
Creator: United States. Government Accountability Office.
Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 1998, CMS established the Special Focus Facility (SFF) Program as one way to address poor performance by nursing homes. The SFF methodology assigns points to deficiencies cited on standard surveys and complaint investigations, and to revisits conducted to ensure that deficiencies have been corrected. CMS uses its methodology periodically to identify candidates for the program--nursing homes with the 15 worst scores in each state--but the program is limited to 136 homes at any point in time because of resource constraints. In 2008, CMS introduced a Five-Star Quality Rating System that draws on the SFF methodology to rank homes from one to five stars. GAO assessed CMS's SFF methodology, applied it on a nationwide basis using statistical scoring thresholds, and adopted several refinements to the methodology. Using this approach, GAO determined (1) the number of most poorly performing homes nationwide, (2) how their performance compared to that of homes identified using the SFF methodology, and (3) the characteristics of such homes."
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Nurse Aide Decision Making in Nursing Homes: Factors Affecting Empowerment

Nurse Aide Decision Making in Nursing Homes: Factors Affecting Empowerment

Date: March 27, 2013
Creator: Chaudhuri, Tanni & Yeatts, Dale E., 1952-
Description: Article on nurse aide decision making in nursing homes and the factors affecting empowerment.
Contributing Partner: UNT College of Public Affairs and Community Service
Geographic Distance, Contact, and Family Perceptions of Quality Nursing Home Care

Geographic Distance, Contact, and Family Perceptions of Quality Nursing Home Care

Date: September 5, 2011
Creator: Dillman, Jennifer L.; Yeatts, Dale E., 1952- & Cready, Cynthia M.
Description: Article on the geographic distance, contact and family perceptions of quality nursing home care.
Contributing Partner: UNT College of Public Affairs and Community Service
The Role of Social Capital in Organizations: The Precursors and Effects of Social Capital among Certified Nurse Aides in Nursing Homes

The Role of Social Capital in Organizations: The Precursors and Effects of Social Capital among Certified Nurse Aides in Nursing Homes

Date: May 2007
Creator: Potts, Helen
Description: The role of social capital in forming organizational commitment is the focus of this research. Organizational social capital is the idea that social relationships have value in the organization. The theoretical framework is based on Kanter's (1993) structure of organizational commitment. This research views the structure within organizations based on global empowerment, job satisfaction, organizational commitment, and social capital. In addition, the role that race, income, and education affect the organizational structure is also taken into account. The organizational configuration was assembled using a structural equation model with latent variables employing a sample of 235 certified nurse aides. The sample was collected from 10 nursing homes in the Dallas-Ft.Worth metropolitan area. It was expected that Kanter's general format is reestablished within the sample. In fact, the study found that empowerment significantly influences job satisfaction. In turn, job satisfaction does foster organizational commitment. Although Kanter's original thesis was supported in this analysis, it was also determined that social capital plays a significant mediating role in creating organizational commitment. Furthermore, this research indicates that social capital alone can create organizational commitment. Thus, in conclusion, this research builds on Kanter's original idea and argues that organizational commitment is based on job satisfaction, global ...
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Nursing Homes: Success of Quality Initiatives Requires Sustained Federal and State Commitment

Nursing Homes: Success of Quality Initiatives Requires Sustained Federal and State Commitment

Date: September 28, 2000
Creator: United States. General Accounting Office.
Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed the quality of care in nursing homes, focusing on: (1) progress in improving the detection of quality problems during annual surveys; (2) how the prevalence of identified problems has changed; (3) the status of efforts to strengthen states' complaint investigation processes and federal enforcement policies; and (4) additional activities occurring at the federal level to improve oversight of states' quality assurance activities."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: HCFA Initiatives to Improve Care Are Under Way but Will Require Continued Commitment

Nursing Homes: HCFA Initiatives to Improve Care Are Under Way but Will Require Continued Commitment

Date: June 30, 1999
Creator: United States. General Accounting Office.
Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) progress in implementing its recent initiatives to strengthen efforts to ensure the quality of care provided by the nation's nursing homes."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Aggregate Medicare Payments Are Adequate Despite Bankruptcies

Nursing Homes: Aggregate Medicare Payments Are Adequate Despite Bankruptcies

Date: September 5, 2000
Creator: United States. General Accounting Office.
Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed the causes of the bankruptcies of large corporations owning nursing homes and the implications for nursing home residents, focusing on: (1) the adequacy of Medicare's payment rates for skilled nursing services furnished in nursing homes; (2) the relationship between the changes wrought by the Balanced Budget Act and recent nursing home bankruptcies; and (3) what exists to protect patients."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Many Shortcomings Exist in Efforts to Protect Residents from Abuse

Nursing Homes: Many Shortcomings Exist in Efforts to Protect Residents from Abuse

Date: March 4, 2002
Creator: United States. General Accounting Office.
Description: Testimony issued by the General Accounting Office with an abstract that begins "Often suffering from multiple physical and mental impairments, the 1.5 million elderly and disabled Americans living in nursing homes are a highly vulnerable population. These individuals typically require extensive help with daily living, such as such as dressing, feeding, and bathing. Many require skilled nursing or rehabilitative care. In recent years, reports of inadequate care, including malnutrition, dehydration, and other forms of neglect, have led to mounting scrutiny from state and federal authorities. Concerns have also been growing that some residents are abused--pushed, slapped, or beaten--by the very individuals to whom their care has been entrusted. GAO found that allegations of physical and sexual abuse of nursing home residents are not reported promptly. Local law enforcement officials said that they are seldom summoned to nursing homes to immediately investigate allegations of abuse and that few allegations are ever prosecuted. Some agencies use different policies when deciding whether to refer allegations of abuse to law enforcement. As a result, law enforcement agencies were never told of some incidents or were notified only after lengthy delays. GAO found that federal and state safeguards intended to protect nursing home residents from ...
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: HCFA Should Strengthen Its Oversight of State Agencies to Better Ensure Quality Care

Nursing Homes: HCFA Should Strengthen Its Oversight of State Agencies to Better Ensure Quality Care

Date: November 4, 1999
Creator: United States. General Accounting Office.
Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed its study of the Health Care Financing Administration's (HFCA) implementation of two of its nursing home initiatives."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Stronger Complaint and Enforcement Practices Needed to Better Ensure Adequate Care

Nursing Homes: Stronger Complaint and Enforcement Practices Needed to Better Ensure Adequate Care

Date: March 22, 1999
Creator: United States. General Accounting Office.
Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed the effectiveness of complaint and enforcement practices to protect nursing home residents, and to ensure that homes participating in Medicare and Medicaid comply with federal standards, focusing on the: (1) effectiveness of states' complaint practices in protecting residents; (2) Health Care Financing Administration's (HCFA) role in establishing standards and conducting oversight of states' complaint practices and in using information about the results of complaint investigations to ensure compliance with nursing home standards; and (3) assessment of HCFA's use of sanction authority for homes that failed to maintain compliance with these standards."
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Private Investment Homes Sometimes Differed from Others in Deficiencies, Staffing, and Financial Performance

Nursing Homes: Private Investment Homes Sometimes Differed from Others in Deficiencies, Staffing, and Financial Performance

Date: July 15, 2011
Creator: United States. Government Accountability Office.
Description: A letter report issued by the Government Accountability Office with an abstract that begins "Private investment (PI) firms' acquisition of several large nursing home chains led to concerns that the quality of care may have been adversely affected. These concerns may have been in part due to PI firms' business strategies and their lack of financial transparency compared to publicly traded companies. In September 2010, GAO reported on the extent of PI ownership of nursing homes and firms' involvement in the operations of homes they acquired. In this report, GAO examined how nursing homes that were acquired by PI firms changed from before acquisition or differed from other homes in: (1) deficiencies cited on state surveys, (2) nurse staffing levels, and (3) financial performance. GAO identified nursing homes that had been acquired by PI firms from 2004 through 2007 and then used data from CMS's Online Survey, Certification, and Reporting system and Medicare Skilled Nursing Facility Cost Reports to compare these PI homes to other forprofit and nonprofit homes. For PIacquired homes, GAO also compared homes for which the operations and real estate were owned by the same firm to those that were not. Because research has shown that other ...
Contributing Partner: UNT Libraries Government Documents Department
Nursing Homes: Some Improvement Seen in Understatement of Serious Deficiencies, but Implications for the Longer-Term Trend Are Unclear

Nursing Homes: Some Improvement Seen in Understatement of Serious Deficiencies, but Implications for the Longer-Term Trend Are Unclear

Date: April 28, 2010
Creator: United States. Government Accountability Office.
Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Federal and state governments share responsibility for ensuring that nursing homes provide quality care in a safe environment for vulnerable elderly or disabled individuals who can no longer care for themselves. States survey nursing homes annually under contract with the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for ensuring the effectiveness of state surveys. To evaluate state surveyors' performance, CMS conducts federal comparative surveys in which federal surveyors independently resurvey a home recently inspected by state surveyors and compare and contrast the deficiencies identified during the two surveys. Federal comparative surveys can find two types of understatement: (1) missed deficiencies, which can occur when a state surveyor fails to cite a deficiency altogether, or (2) cases where state surveyors cite deficiencies at too low a level. In May 2008, we reported that a substantial proportion of federal comparative surveys conducted from fiscal years 2002 through 2007 identified missed deficiencies that either had the potential to or did result in harm, death, or serious injury to nursing home residents."
Contributing Partner: UNT Libraries Government Documents Department
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