Nursing Home Quality Improvement Initiative

Questions to Ask Facilities

Long Term (chronic care) Residents

Percent of residents whose need for help with daily activities has increased

Questions you can ask the facility if it is rated high in this measure:

• How many of the residents who decline in ability to perform basic daily tasks suffered new medical conditions, such as stroke?
• How does the facility assess residents for lack of independence in doing basic daily tasks?
• How does the facility encourage residents to willingly initiate or participate in self-care?
• What rehabilitative care does the facility provide to residents to maintain or expand self-care?

Percent of residents who have moderate to severe pain

Questions you can ask the facility if it is rated high in this measure:

• What signs and symptoms suggest to the facility that a resident may be in pain, and how often do they monitor for pain?
• How does the facility identify causes of pain, and how does it determine whether the cause can or cannot be corrected?
• Other than ordering pain medications, what treatments are used to relieve pain?
• What does the facility do if a patient refuses medication for pain?
• How does the facility monitor the effectiveness and risk to benefit of pain intervention?

Percent of residents who were physically restrained

Questions you can ask the facility if it is rated high in this measure:

• How does the facility decide when restraints are needed, or decide that less restrictive alternatives are not workable?
• How does a facility determine whether a patient's restraints are still necessary?
• How does the facility know the restraint is doing what it's supposed to do, and watch for complications?
• Does the facility have a restraint reduction program or policy?
• Does the staff help the restrained resident move as much as is practical?

Percent of high-risk residents who have pressure sores

Questions you can ask the facility if it is rated high in this measure:

• How many residents with pressure sores were admitted with the sores?
• What percent of residents with pressure sores are high risk residents (impaired mobility or transfer, comatose, or malnourished)?
• How many residents with pressure sores have a terminal illness?
• How does the facility assess residents for risk factors for developing pressure sores?
• How often does the facility assess residents for skin breakdown or pressure ulcers?
• How does the facility try to prevent pressure ulcers, especially when dealing with high risk patients?
• Does the facility have a wound care program, and how does it work?

Percent of low-risk residents who have pressure sores

Questions you can ask the facility if it is rated high in this measure:

• How many residents with pressure sores were admitted with the sores?
• What percent of residents with pressure sores are low-risk residents (able to move about and be active, change positions, and well nourished)?
• How many residents with pressure sores have a terminal illness?
• How does the facility assess residents for risk factors for developing pressure sores?
• How often does the facility assess residents for skin breakdown or pressure sores?
• How does the facility try to prevent pressure sores?
• Does the facility have a wound care program, and how does it work?

Percent of residents with a urinary tract infection

Questions you can ask the facility if it is rated high in this measure:

• How does the facility determine when to test residents for urinary tract infections (UTIs)?
• How does the facility determine whether to treat incontinent residents who have positive test results for UTIs but have no symptoms?
• How does the facility try to prevent urinary tract infections?
• How are residents with recurrent urinary tract infections evaluated?

Percent of residents who spent most of their time in bed or in a chair

Questions you can ask the facility if it is rated high in this measure:

• How many of the residents are bedridden or spend most of their time in a chair?
• What does the facility do to encourage residents to participate in physical activity?
• What does the facility do to encourage residents to participate in social activity?
• What rehabilitative care does the facility provide to residents to expand their activity?
• How does the facility try to improve the quality of life for those residents that remain bedridden?

Percent of residents who have become more depressed or anxious

Questions you can ask the facility if it is rated high in this measure:

• How many of these residents have been recently hospitalized and why?
• How many of these residents have worsening medical conditions or chronic psychiatric disease?
• How does the facility look for underlying causes of increased depression and anxiety?
• How does the facility decide that consultation with a psychiatric specialist is needed?

Percent of low-risk residents who lose control of their bowels or bladder

Questions you can ask the facility if it is rated high in this measure:

• How does the facility determine the cause of loss of bowel or bladder control?
• How many residents are restrained, and what's the procedure for their use?
• How often does staff help mobility impaired residents use the bathroom?
• How does the facility help the resident restore bowel or bladder control?
• How does the facility avoid complications such as pressure ulcers in these residents?

Percent of residents who have/had a catheter inserted and left in their bladder

Questions you can ask the facility if it is rated high in this measure:

• Under what conditions does the facility recommend insertion of a catheter?
• What does the facility do to prevent complications from using a catheter, such as urinary tract infections?
• How does the facility restrict use of indwelling catheters?
• How does the facility maintain and monitor use of catheters?

Percent of residents whose ability to move about in and around their room got worse

Questions you can ask the facility if it is rated high in this measure:

• How many of the residents do not take part in activities?
• What does the facility do to encourage residents to participate in physical activity?
• What does the facility do to encourage residents to participate in social activity?
• What rehabilitative care does the facility provide to residents to expand physical activity?
• What rehabilitative care does the facility provide to residents to expand social activity?
• Does the facility have an active restorative care program?
• What is the facility's walking program?
• How is the doctor involved in persons who decline in mobility?

Percent of chronic/long term care residents who lose too much weight

Questions you can ask the facility if it is rated high in this measure:

• How does the facility determine the cause of weight loss in patients?
• How flexible is the facility in tailoring meals and foods to individual preferences?
• Does the facility have a program to rapidly and correctly notice change in nutrition?
• How does the facility address issues that may affect the eating environment in the nursing facility?
• Do the health care providers ensure that decisions concerning tube feedings reflect the patient's preferences as far as they can be known, balanced by a realistic appraisal of the patient's progress?

Short-stay (temporary) Residents

Percent of short stay residents who had moderate to severe pain

Questions you can ask the facility if it is rated high in this measure:

• What signs and symptoms suggest to the facility that a resident may be in pain, and how often do they monitor for pain?
• How does the facility identify causes of pain, and how does it determine whether the cause can or cannot be corrected?
• Other than ordering pain medications, what treatments are used to relieve pain?
• What does the facility do if a patient refuses medication for pain?
• How does the facility monitor the effectiveness and risk to benefits of pain intervention?

Percent of short stay residents with delirium

Questions you can ask the facility if it is rated high in this measure:

• How many of the residents who have delirium were admitted into the facility with delirium?
• How does the facility identify and assess delirium in a timely fashion, especially in those coming from the hospital?
• How does the facility ensure that a doctor or other healthcare professional such as a nurse practitioner is involved in diagnosing and managing delirium?
• How does the facility investigate factors that may contribute to delirium in its residents? For example, how does the facility monitor fluid balance and side effects of medications?

Percent of short stay residents with pressure sores

Questions you can ask the facility if it is rated high in this measure:

• How many residents with pressure sores were admitted with the sores?
• How many residents with pressure sores have a terminal illness?
• How does the facility assess residents for risk factors for developing pressure sores?
• How often does the facility assess residents for skin breakdown or pressure sores?
• How does the facility try to prevent pressure sores, especially in high risk persons?
• Does the facility have a wound care program, and how does it work?