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Nursing Home Care in the USA

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Geriatric Medicine

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Abstract

Nursing homes (NHs) remain a critical element of the healthcare continuum, accommodating an increasingly frail and dependent population of primarily older adults. The NH Reform Act of 1987 dramatically changed the provision of care in NHs by setting quality standards and defining key processes of care. The majority of NHs are for-profit, have an average of 106 beds, and operate within a strict regulatory framework defined by both federal and state government. Medical care in the NH is provided by physicians, nurse practitioners, and physician assistants under the stewardship of the medical director. Specific medical staff organizational models exist, some of which have been associated with improved care outcomes. The delivery of medical care in the NH is complex given the high prevalence of physical and psychological illness. Timely and accurate diagnosis and treatment is challenging as medical providers are often not on site and resources in the NH are constrained. Mandated quality improvement processes assure timely problem identification and continuous performance improvement.

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References

  1. Katz PR, Calkins E, editors. Principles and practice of nursing home care. New York: Springer; 1989.

    Google Scholar 

  2. National Center for Health Statistics. Vital and health statistics: long-term care providers and services users in the United States, 2015–2016, Series 3, Number 43. [Internet]. 2019 [cited 2021 March 30]. Available from: https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf.

  3. Fashaw SA, Thomas KS, McCreedy E, Mor V. Thirty-Year trends in nursing home composition and quality since the passage of the Omnibus Reconciliation Act. J Am Med Dir Assoc. 2019;21(2):233–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rivera-Hernandez M, Rahman M, Mukamel DB, Mor V, Trivedi AN. Quality of post-acute care in skilled nursing facilities that disproportionately serve black and Hispanic patients. J Gerontol A Biol Sci Med Sci. 2019;74(5):689–97.

    Article  PubMed  Google Scholar 

  5. Werner RM, Hoffman AK, Coe NB. Long-term care policy after COVID-19 – solving the nursing home crisis. N Engl J Med. 2020;383:903–5.

    Article  CAS  PubMed  Google Scholar 

  6. Elon R, Pawlson LG. The impact of OBRA on medical practice within nursing facilities. J Am Geriatr Soc. 1992;10(9):958–63.

    Article  Google Scholar 

  7. Medicare and Medicaid Programs. Requirements for long-term care facilities: regulatory provisions to promote efficiency, and transparency. 2019, 84 FR 34737. [cited 2021 March 30]. Available from: https://www.federalregister.gov/documents/2019/07/18/2019-14946/medicare-and-medicaid-programs-requirements-for-long-term-care-facilities-regulatory-provisions-to.

  8. Electronic Code of Federal Regulations [Internet]. College Park, MD: National Archives and Records Administration’s Office of the Federal Register and Government Publishing Office. [updated 2021 march 26; cited 2021 March 30]. Available from: https://www.ecfr.gov/cgi-bin/ECFR?page=browse.

  9. State Operations Manual: 100-07 [Internet]. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services [updated 2020 Jan 21; cited 2021 March 30]. Available from: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984.

  10. Find and compare nursing homes, hospitals and other providers near you [Internet]. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services [updated 2021 Feb 18; cited 2021 March 30]. Available from: https://www.medicare.gov/care-compare/?providerType=NursingHome&redirect=true.

  11. Medicare Skilled Nursing Facility (SNF) Transparency Data (CY2013) [Internet]. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services [updated 2016 March 9; cited 2021 March 30]. Available from: https://www.cms.gov/newsroom/fact-sheets/medicare-skilled-nursing-facility-snf-transparency-data-cy2013.

  12. Harrington C, Dellefield ME, Halifax E, Fleming ML, Bakerjian D. Appropriate nurse staffing levels for U.S. nursing homes. Health Serv Insights. 2020;13:1–14.

    Google Scholar 

  13. PHI. U.S. nursing assistants employed in nursing homes: key facts. [Internet]. 2017 [cited 2021 March 30]. Available from https://phinational.org/resource/u-s-nursing-assistants-employed-in-nursing-homes-key-facts/.

  14. Tyler DA, Feng Z, Leland NE, Gozalo P, Intrator O, Mor V. Trends in postacute care and staffing in US nursing homes, 2001–2010. J Am Med Dir Assoc. 2013;14(11):817–20.

    Article  PubMed  Google Scholar 

  15. Harrington C, Schnelle JF, McGregor M, Simmons SF. Article commentary: the need for higher minimum staffing standards in U.S. nursing homes. Health Serv Insights. 2016;9:13–9.

    PubMed  PubMed Central  Google Scholar 

  16. Scales K. It is time to resolve the direct care workforce crisis in long-term care. Gerontologist. 2020;gnaa116.

    Google Scholar 

  17. Katz PR, Karuza J, Intrator O, Mor V. Nursing home physician specialists: a response to the workforce crisis in long-term care. Ann Intern Med. 2009;150(6):411–3.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Katz PK, Ryskina K, Saliba D, Costa A, Jung HY, Wagner LM, et al. Medical care delivery in us nursing homes: current and future practice. Gerontologist. 2020;gnaa141.

    Google Scholar 

  19. Katz PK, Karuza J, Lima J, Intrator O. Nursing home medical staff organization: correlates with quality indicators. J Am Med Dir Assoc. 2011;12(9):655–9.

    Article  PubMed  Google Scholar 

  20. Katz PR, Wayne M, Evans J, Gelman L, Majette SL. Examining the rationale and processes behind the development of AMDA’s competencies for post-acute and long-term care. Ann Longterm Care. 2014;22(11):36–9.

    Google Scholar 

  21. Mays AM, Saliba D, Feldman S, Smalbrugge M, Hertogh CMPM, Booker TL, et al. Quality indicators of primary care provider engagement in nursing home care. J Am Med Dir Assoc. 2018;19(10):824–32.

    Article  PubMed  Google Scholar 

  22. Ryskina KL, Yuan Y, Werner RM. Postacute care outcomes and Medicare payments for patients treated by physicians and advanced practitioners who specialize in nursing home practice. Health Serv Res. 2019;54(3):564–74.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kuo YF, Raji MA, Goodwin JS. Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents. J Am Med Dir Assoc. 2013;61(10):1750–7.

    Google Scholar 

  24. Ryskina KL, Lam C, Jung HY. Association between clinician specialization in nursing home care and nursing home clinical quality scores. J Am Med Dir Assoc. 2019;20(8):1007–12.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Teno JM, Gozalo PL, Trivedi AN, Mitchell SL, Bunker JN, Mor V. Temporal trends in the numbers of skilled nursing facility specialists from 2007 through 2014. JAMA Intern Med. 2017;177(9):1376–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Martin-Misener R, Donald F, Wickson-Griffiths A, Akhtar-Danesh N, Ploeg J, Kaasalainen S, et al. A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes. J Clin Nurs. 2015;24(9–10):1327–37.

    Article  PubMed  Google Scholar 

  27. McAiney CA, Ploeg J, Wickson-Griffiths A, Kaasalainen S, Martin-Misener R, Akhtar-Danesh N, et al. Perspectives of nurse-practitioner-physician collaboration among nurse practitioners in Canadian long-term care homes: a national survey. Nurs Leadersh. 2017;30(4):10–25.

    Article  Google Scholar 

  28. National Commission on Certification of Physician Assistants. 2019 statistical profile of certified physician assistants. National Commission on Certification of Physician Assistants. [Internet]. 2019 [cited 2021 March 30]. Available from: https://prodcmsstoragesa.blob.core.windows.net/uploads/files/2019StatisticalProfileofCertifiedPhysicianAssistants.pdf.

  29. McGarry BE, Grabowski DC. Managed care for long-stay nursing home residents: an evaluation of institutional special needs plans. Am J Manag Care. 2019;25(9):438–43.

    PubMed  Google Scholar 

  30. Oslander JG, Berenson RA. Reducing unnecessary hospitalizations of nursing home residents. N Engl J Med. 2011;365(13):1165–7.

    Article  Google Scholar 

  31. Kane RL, Huckfeldt P, Tappen R, Engstrom G, Rojido C, Newman D, et al. Effects of an intervention to reduce hospitalizations from nursing homes. JAMA Int Med. 2017;177(9):1257–64.

    Article  Google Scholar 

  32. Unroe KT, Nazir A, Holtz LR, Maurer H, Miller E, Hickman SE, et al. The optimizing patient transfers, impacting medical quality, and improving symptoms: transforming institutional care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services Nursing Facility Demonstration Project. J Am Geriatr Soc. 2015 Jan;63(1):165–9.

    Article  PubMed  Google Scholar 

  33. Rowland FN, Cowles M, Dickstein C, Katz PR. Impact of medical director certification on nursing home quality of care. J Am Med Dir Assoc. 2009;10(6):431–5.

    Article  PubMed  Google Scholar 

  34. QAPI Description and Background [Internet]. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services [updated 2016 Sept 20; cited 2021 March 30]. Available from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapidefinition.

  35. QAPI: Quality Assurance & Performance Improvement [Internet]. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services [updated 2021 March 20; cited 2021 March 30]. Available from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/NHQAPI.

  36. Katz PK. An international perspective on improving physician care in nursing homes. J Am Med Dir Assoc. 2020 March;21(3):295–6.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Hebrew SeniorLife, Boston, MA, USA

    Innokentiy Bakaev

  2. University of Rochester Medical Center, Rochester, NY, USA

    Suzanne M. Gillespie

  3. The Florida State University College of Medicine, Tallahassee, FL, USA

    Casey Rust & Paul Katz

Authors
  1. Innokentiy Bakaev
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  2. Suzanne M. Gillespie
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  3. Casey Rust
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  4. Paul Katz
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Corresponding author

Correspondence to Paul Katz .

Editor information

Editors and Affiliations

  1. California Association of Long Term Care Medicine, Newbury Park, CA, USA

    Michael R. Wasserman

  2. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Debra Bakerjian

  3. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Sunny Linnebur

  4. Division of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA

    Sharon Brangman

  5. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari

  6. Section of Geriatric Medicine, Division of Internal Medicine, Department of Medicine, Cedars-Sinai, Beverly Hills, CA, USA

    Sonja Rosen

Section Editor information

  1. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California, USA

    Debra Bakerjian PhD, APRN, FAAN, FAANP

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Bakaev, I., Gillespie, S.M., Rust, C., Katz, P. (2024). Nursing Home Care in the USA. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_21

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  • DOI: https://doi.org/10.1007/978-3-030-74720-6_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74719-0

  • Online ISBN: 978-3-030-74720-6

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