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Nursing Home Quality

Posted Jan 31 2013 12:00am

Typically, Nursing Home quality is measured using metrics from Nursing Home Compare . These metrics are calculated based on survey and certification processes and resident assessments from from the Minimum Data Set (MDS). These, however, are not the only quality metrics one can use. For instance, one can use consumer complaints as a measure of quality (or lack thereof).

In each state, complaints can be made to the certification agency (i.e., the state agency responsible for the annual inspection) as well as the Long-Term Care Ombudsman Program. The advantage of using ombudsman complaints rather than compliants to the certification agencies is that the Ombudsman is in contact with the residents in nursing facilities on an ongoing basis.

To determine the relationship between nursing home quality measured on Nursing Home Compare and quality measured by complaints, a paper by Troyer and Sause (2012) considers complaints against nursing homes in North Carolina to the NC Ombudsman and the North Carolina Division of Health Service Regulation (DHSR). The authors find the following:

The relationship between the two types of complaints and other quality measures is complex. First, MDS health outcome measures are unrelated to the volume of both types of complaints. Consistent with Stevenson’s (2005) study of Massachusetts complaints, complaints to both the DHSR and the Ombudsman appear to be measuring different dimensions of quality than the MDS-QIs.

The relationship between the number of deficiencies and Ombudsman complaint levels is quite weak, supporting the notion that Ombudsman complaints cannot forecast deficiencies and do not overlap with quality concerns uncovered in the inspection process…In contrast…there are positive and significant relationships between deficiencies found during the state certification survey and current and subsequent DHSR complaint volume in many categories. We also find that the number of DHSR complaints is strongly associated with deficiencies found in the current or next quarter.

How would these findings affect policy? The authors recommend monitoring complaints between state certification agency inspections and identify mechanisms whereby a high volume of compliants would trigger an off-cycle inspections or more frequent visits by the Ombudsman.

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