2021 and the Quality of Healthcare – A View from the Battlefield

The theme for 2021 Healthcare Quality Week is Sustainability: Improving Our Products, People and Planet. This is a sorely needed goal and requires an awareness of the issues and an acceptance of the need for change. 

Good healthcare does not just happen but takes thoughtful planning and timely responses to issues threatening quality. Quality cannot be compelled, and it cannot be achieved if the ingredients to provide it are not available. The long months of the pandemic and the damage and losses left in its wake make reaching the current standards for high-quality healthcare almost impossible to meet. The pandemic also exposed gaps and weaknesses in our system that add to the challenges.

The old ways of providing healthcare in the skilled care setting are no longer acceptable and not often possible. Clinicians and frontline caregivers are exhausted, stressed out, and burned out. Some have left the field, some are barely hanging on, and many want to stay but are finding it increasingly difficult. Something must be done. Otherwise, workforce challenges and other problems will be insurmountable. 

What is Standing in the Way of Quality?

The American Health Care Association (ACHA) present an excellent summary article giving ample evidence that the surviving long term care healthcare professionals are tired, many with post-traumatic stress disorder, lacking meaningful support from Centers for Medicare and Medicaid (CMS), trying to meet basic needs with old approaches while owners and operators are looking for new ways to survive or ways to close their doors.

The Situation: ACHA Highlights

  • Staffing is the number one challenge
    • Shortage of tools and resources to implement mandatory staffing requirements
    • “Price gouging” by staffing agencies when admissions cut due to the staffing 
    • CMS posting turnover rates and making it part of the Five-Star Quality Rating System is not the answer to the staffing crisis 
  • Payment Driven Payment Model (PDPM)
    • No surprise – it is not “budget neutral” so recalibration is anticipated
    • More critical than ever to monitor and analyze PDPM data 
    • Providers must show outcomes related to the PDPM coding changes 
  • Compliance is not optional
    • Facilities must have a way to self-evaluate and correct — with access to data being a key component

The quality we want to provide and the outcomes we want to achieve will not just happen, especially with these challenges today. We must examine our current practices and be deliberate in identifying next steps. The IOM recommends changes consistent with current professional knowledge. AHCA recommends finding tools and resources to manage staffing, monitoring PDPM data more frequently, and accessing data to self-evaluate and correct.

The Solution: Patient Pattern Software

The issues addressed by AHCA are being experienced by all skilled nursing facilities. The supply of caregivers is limited. Having learned from the pandemic that frailty increases the risk for further decline, staff is struggling to manage risks, avoid bad outcomes, and work at rebuilding public trust and confidence, unfairly lost or diminished during the pandemic. In this environment, without a commitment to change the focus and processes of care, it will be very difficult to improve quality and perhaps even to survive.

As a company focused on frailty across the continuum of care, our products are designed not only to measure, manage, and mitigate frailty but are intended to educate all caregivers on the topic of frailty and to recommend an application of frailty that will help with the staffing shortage.  Since the nursing home residents of today are older, sicker, frailer, and require far more clinical expertise than the “custodial care” model of the past, it is appropriate and beneficial to measure frailty. 

Our software solutions are designed to guide high-quality care, based on current professional standards (IOM definition), and a) to provide tools and resources to manage staffing, b) monitor PDPM data, c) allow access to data for self-evaluation and correction, and 4) identify those at highest risk to enable proactive approaches to manage their outcomes. Understanding and recognizing frailty is crucial to providing good quality care. With national scrutiny of nursing home care, regulatory reform aimed at identifying quality in care, and person-centered approaches, frailty, as an indicator of risk for poor outcomes, should inform care planning and whenever possible be incorporated into the assessment and decision-making of all professionals caring for older adults across the continuum of care.

Everyone with an opinion about the current crisis in long-term care agrees that the problems are not new, did not happen overnight, are multifactorial, and they will take a multi-pronged approach to correct. This requires time, money, and the will to make change happen. If you and your skilled facility wants to explore a new approach for change, consider the following opportunities:

Contact us at patientpattern.com for a demonstration of the software solution that addresses your specific area of need.

 Contact us at frailtycertification.com for information about the online learning opportunity to learn about frailty and how you can incorporate frailty into your specific role.

We look forward to helping you be a positive agent of change and win victories in terms of better outcomes, staffing, census, and reimbursement.