Nursing Home Quality Improvement Initiative

Questions and Answers

What are the Nursing Home Quality Measures?
The numbers are only a starting point for asking questions about a facility's care. CMS has broken down the Quality Measures into two categories: one category mainly for long term residents (chronic care), and the other for short stay (post-hospital care) residents.

Click on each Quality Measure for a definition, explanation, and questions you can ask the facility.

• Percent of residents whose need for help with daily activities has increased
• Percent of residents who have moderate to severe pain
• Percent of residents who were physically restrained
• Percent of high-risk residents who have pressure sores
• Percent of low-risk residents who have pressure sores
• Percent of residents with a urinary tract infection
• Percent of residents who spent most of their time in bed or in a chair
• Percent of residents who have become more depressed or anxious
• Percent of low-risk residents who lose control of their bowels or bladder
• Percent of residents who have/had a catheter inserted and left in their bladder
• Percent of residents whose ability to move about in and around their room got worse
• Percent of chronic/long term care residents who lose too much weight

Short-stay (temporary) Residents

• Percent of short stay residents who had moderate to severe pain
• Percent of short stay residents with delirium
• Percent of short stay residents with pressure sores

All of the quality measures are negative measures; in other words, they measure a condition that is undesirable.

What is risk adjustment?
In some cases, the Quality Measures are risk adjusted. For example, the Quality Measure for residents whose need for help with daily activities has increased will exclude residents who are comatose, have end-stage disease, or are receiving hospice care. These persons are expected to decline and don't measure quality in this area.

How should I use this information?
CMS has developed this initiative to give consumers more information about the quality of care in nursing homes (online at www.medicare.gov/NHCompare). However, you should not jump to conclusions about the quality of care at a nursing home based on these Quality Measures alone. For example, a home that specializes in wound care may accept many patients with bedsores and only appear to have a high number of pressure ulcers. A different home may have had problems with pressure ulcers but be making major changes to improve care. You should use the information as a starting point for asking questions of the professionals at the facility.

What do the physicians who work in nursing homes say about these Quality Measures?
Physicians who work in nursing homes care about their patients and want the public to have access to al available information about quality of their care. However, the CMS Quality Measures, by themselves, may be difficult to interpret. If you have concerns about quality of care, the medical director, attending physician, administrator, or director of nursing at the nursing home are your best information resources. Your physician can help explain how this information can help in your decision-making and what other information you should consider.

Where did CMS get their data? Information about facility residents has been collected for years. When a person is admitted to a nursing home, the nursing facility staff does an assessment of the resident's condition. That information is then sent to CMS, which then provides it to state survey agencies (which are responsible for evaluating nursing homes each year) to use during their survey process. Surveyors are supposed to use those percentages as a starting point for their investigations. For example, if a facility has a high percentage of pressure sores, the surveyors will want to see if the facility has a wound care program and how many residents were admitted to the facility with the sores already present. The surveyors are also supposed to consider how the facility tries to prevent and treat pressures sores. Information about each resident is included in the data (for example, which individuals have pain or pressure sores) and about the facility's total results (for example, overall incidence of pressure sores in the facility). In the information published for consumers, each facility is then compared to other facilities in that state. A facility's rating (percentile rank) represents the percentage of facilities in that state whose results are lower or smaller for that condition.