Information for Institutional Services

Home and community-based services are increasingly popular as an alternative to institutions such as nursing homes and ICF-MR/DD facilities serving people with intellectual and developmental disabilities. The Medicare (for the aged and disabled) and Medicaid (for individuals with low incomes) programs pay for some long term care services. Unfortunately, these public programs have been biased in favor of paying for institutional services more than for home and community services because institutional services are mandatory programs under the federal law for individuals who meet the eligibility criteria.

Nursing home and home health services are paid for by Medicare for those individuals needing short-term rehabilitation care. Medicaid is a major payer for nursing home and home and community services including personal care for individuals who meet the low income criteria and need assistance. Access to Medicaid home and community services and personal care varies by state depending upon state policy decisions, whereas all states must offer nursing home and ICF-MR/DD services.

In order to better understand home and community services, it is useful to compare these services to institutional care. The PAS Center has developed this section to provide detailed information on nursing homes and other institutional services. The information includes statistics on the supply, residents, and quality of services by state and across the nation. If you have other specific questions about institutional care, please contact us.


State by State Data on Nursing Homes

A new report has been completed by the University of California, San Francisco, showing trends in U.S. nursing homes by state for the 2005 through 2010. The data are from the federal On-Line Survey and Certification System (OSCAR) reports that are completed at the time of the annual nursing home surveys by state Licensing and Certification programs for the U.S. Centers for Medicare and Medicaid Services.


Nursing Home Transparency and Improvement Act

The nursing home transparency provisions are the first comprehensive improvements in nursing home quality since the Omnibus Reconciliation Act of 1987. When the act is fully implemented, the law will provide consumers a substantial amount of new information about individual facilities, most of it from resolutions passed by members of the National Consumer Voice for Quality Long Term Care. The legislation was sponsored by Senator Herb Kohl (D-WI), Senator Chuck Grassley (R-IA), Rep. Henry Waxman (D-CA), Rep. Pete Stark (D-CA) and Rep. Jan Schakowsky (D-IL).

Key provisions of the act include:

  • Public disclosure of nursing home owners, operators, and other entities and individuals that provide management, financing, and services to nursing homes.
  • Establishment of internal procedures by nursing homes ("compliance and ethics programs") to reduce civil and criminal violations and improve quality assurance.
  • Collection of staffing data electronically from payroll records and other verifiable sources and public reporting of hours per resident day of care and turnover and retention rates.
  • Improved public information on Nursing Home Compare, including staffing data for each facility that includes hours of care per resident day, turnover, and retention rates; links to facilities' survey reports (Form 2567) and plans of correction on state websites; summaries of complaints against facilities, including number, type, severity and outcome; a standardized complaint form; and adjudicated criminal violations by facilities and their employees inside the facility, including civil monetary penalties levied against the facility, its employees, contractors, and other agents.
  • Establishment of a consumer rights information page on Nursing Home Compare, including services available from the long-term care ombudsman.
  • A review of Nursing Home Compare's accuracy, clarity, timeliness, and comprehensiveness and modifications of the site based on the review.
  • A Government Accountability Office study of the Five Star Quality Rating System.
  • Improved timeliness of survey information made available to the public.
  • A requirement for nursing homes to make surveys and complaint investigations for three years available on request and to post a notice that they are available.
  • A requirement that states maintain a website with information on all nursing homes in the state, including survey reports (Form 2567), complaint investigation reports, plans of correction, and other information that the state or CMS considers useful.
  • A statutory requirement for a special focus facility program.
  • Establishment of a methodology for categorization and public reporting of facilities' expenditures, regardless of source of payment, for direct care (including nursing, therapy, and medical services); indirect care (including housekeeping and dietary services); capital assets; and administrative services.
  • Improved complaint handling, including a voluntary standardized form for filing complaints with the survey agency and ombudsman; and protection of residents' legal representatives and other responsible parties from retaliation when they complain about quality of care.
  • Escrowing of civil monetary penalties after an independent informal dispute resolution process and pending resolution of further appeals. (Allows for reduction of CMP amounts for self-reported,non-repeat violations.)
  • Sixty-day advance notification of facility closure and authorization to continue Medicaid payments pending relocation of all residents.
  • Dementia care and abuse prevention in nurse aide training programs.
  • Demonstration projects to identify best practices in culture change and information technology.
  • Demonstration program to develop, test, and implement federal oversight of interstate and large intrastate chains. (Chains apply to participate in the demonstrations.)

For more information go to:

http://www.theconsumervoice.org/sites/default/files/advocate/whats-new/Nursing-Home-Transparency-Act-Requirements-and-Implementation-Dates.pdf.

Retrieved from http://www.theconsumervoice.org, 4/13/2010.


Ombudsmen for Residents of Nursing Homes and Assisted Living

An Ombudsman is an advocate for residents of nursing homes, board and care homes, and assisted living. They are authorized by federal and state law to provide information about:

  • How to find a facility and what to do to get quality care
  • To answer questions related to long term care
  • identify, investigate and resolve complaints on behalf of residents

The following link provides contact information for state Ombudsmen and Regional Offices.

Contact Info for State Ombudsmen and Regional Offices.

Additional information on what an Ombudsman does can be found at www.ltcombudsman.org/about-ombudsmen

Information on what an Ombudsmen can do for residents of nursing homes and assisted living centers can be found at http://www.assisted-living-directory.com/content/ltc-ombudsman.cfm


State by State Nursing Home Staffing Standards Report

Nursing facilities are required by federal regulation to meet minimum standards, which require a minimum of one registered nurse on duty eight hours per day seven days a week. Facilities must also have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of residents. Facilities must also provide sufficient numbers of licensed nursing personnel to provide care on a 24 hour basis to all residents in accordance with resident care plans.

A number of states have developed staffing standards that have greater requirements than the federal standards. The following report shows the state staffing standards. Studies have also shown that states with higher staffing standards have more nursing hours of actual care for residents. The adequacy of nurse staffing levels continues to be a major concern in nursing homes and RN staffing levels have dropped by 25 percent since 2000. Advocates are continue to work on staffing improvements in nursing homes especially at the state level.


Nursing home Certification and Compliance

The Centers for Medicare and Medicaid Services (CMS) has recently released the 2007, Nursing Home Data Compendium. The compendium contains figures and tables presenting data on all residents in Medicare- and Medicaid-certified nursing homes in the United States. A series of graphs and maps high-lights some of the most interesting data, while detailed data are available in accompanying tables. The tables and figures in the compendium were compiled from CMS survey and certification administrative data and nursing home clinical data contained in the Minimum Data Set (MDS).

The Compendium is available as a link from the bottom of the following page:
http://www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp#TopOfPage


Evaluation of California's Long Term Care Reimbursement Act

Researchers at the University of California released an evaluation of impact of California's Long Term Care Reimbursement Act of 2004 (AB 1629) that showed that Medi-Cal costs for nursing homes increased by $590 million between 2004 and 2006 without improvements in quality or access to care. Total costs for California's free-standing nursing homes were $6.6 billion in 2006. The Long Term Care Reimbursement Act was designed to improve the quality of nursing home care by increasing Medi-Cal reimbursement rates, using a payment system based on actual costs of care for each facility with certain costs ceilings. Implemented in 2004-05, the system raised Medi-Cal rates from $124 per day in 2004 to $152 per day in 2006. The report showed that access for Medi-Cal residents, quality of care in nursing homes did not improve between 2004 and 2006. Expenditures for administrative costs increased and net income margins improved over the period.


Reports and Publications

A list of reports and publications produced by the Institutional Services project. The citations have links to press releases, abstracts, and either the entire publication or information on where to obtain it.

All Institutional Services project reports and publications

Recent additions

Harrington, C., Ross, L., Mukamel, D. & Rosenau, P. (2013, June). Improving the Financial Accountability of Nursing Facilities. Washington, D.C.: Kaiser Commission on Medicaid and the Uninsured.  Read more about the publication, Improving the Financial Accountability of Nursing Facilities.

Kaiser Commission on Medicaid and the Uninsured. (2013, June). Overview of Nursing Facility Capacity, Financing, and Ownership in the United States in 2011. Washington, D.C.: Author.  Read more about the publication, Overview of Nursing Facility Capacity, Financing, and Ownership in the United States in 2011.

LaPlante, M.P. (2013). The Woodwork Effect in Medicaid Long-Term Services and Supports. Journal of Aging & Social Policy, 25:2, pp.161-180. doi: 10.1080/08959420.2013.766072 Read more about the publication, The Woodwork Effect in Medicaid Long-Term Services and Supports.


Library

Citations and abstracts of important publications related to Institutional Services. Information on how to obtain the complete text is provided with each citation.

All Institutional Services publications

Recent additions:

The SCAN Foundation (2013, September) Extended Stay Nursing Facility Admissions for California's Medicare-Medicaid Enrollees, 2006-2008. Long Beach, CA. The SCAN Foundation. Read more about the publication, Extended Stay Nursing Facility Admissions for California´s Medicare-Medicaid Enrollees, 2006-2008.

Dennison, T.H. (2013, August). New York's Nursing Homes: Shifting Roles and New Challenges. Long Beach, CA: United Hospital Fund.  Read more about the publication, New York´s Nursing Homes: Shifting Roles and New Challenges.

Hagen, S. (2013, June). Rising Demand for Long-Term Services and Supports for Elderly People. Washington, D.C.: Congressional Budget Office.  Read more about the publication, Rising Demand for Long-Term Services and Supports for Elderly People.


Presentations

A list of presentations given by the Institutional Services project with links to summaries and powerpoint files.

All Institutional Services Presentations

Recent additions

Harrington, C., & Kang, T. (2007, Nov 19) Age and Race Disparities in Home and Community Based Services for the Developmentally Disabled. Poster. Presented at the 60th Annual Scientific Meeting of The Gerontological Society of America hosted by The Gerontological Society of America.

Read more about this presentation titled, Age and Race Disparities in Home and Community Based Services for the Developmentally Disabled. Poster

Hyer, K., & Harrington, C. (Discussants) (2007, Nov 18) Impact of Florida Legislative and Regulatory Innovations on Nursing Homes. Presented at the 60th Annual Scientific Meeting of The Gerontological Society of America hosted by The Gerontological Society of America.

Read more about this presentation titled, Impact of Florida Legislative and Regulatory Innovations on Nursing Homes

Dellefield, M., & Harrington, C. (2007, Nov 17) Improving Quality: Work Sampling of Registered Nurse Work Activities. Poster.. Presented at the 60th Annual Scientific Meeting of The Gerontological Society of America hosted by The Gerontological Society of America.

Read more about this presentation titled, Improving Quality: Work Sampling of Registered Nurse Work Activities. Poster.

Links

A list of links to organizations, resources and information available on the web related to Institutional Services.

All Institutional Services Links

Recent additions: