The Center for Medicare Advocacy recently published a press release on the failure of nursing homes participating in the "Advancing Excellence in America’s Nursing Homes"–an industry program to self-police and improve quality of care.  Below are excerpts of the press release:

Many nursing facilities that are identified by the federal government as among the facilities providing the poorest quality of care to residents in the country – the Special Focus Facilities (SFFs) – participate in the nursing home industry’s voluntary quality improvement campaign, Advancing Excellence in America’s Nursing Homes.  Forty-three percent of all facilities identified by the Centers for Medicare & Medicaid Services (CMS) as SFFs have participated in Advancing Excellence for more than two years.

Participation in Advancing Excellence has neither prevented facilities from being identified as SFFs nor helped them improve the quality of care they provide to residents to warrant removal from the SFF list.  That nursing facilities participating in a quality improvement campaign are nevertheless identified by the federal government as among the most poorly performing facilities in the country demonstrates, once again, that voluntary quality improvement efforts by the nursing home industry do not guarantee high quality of care for residents and cannot replace a strong public regulatory system.

Each month, CMS identifies nursing facilities that are providing the poorest care to their residents, as determined by federal deficiencies cited in the prior three years. There are 15,568 nursing facilities in the United States. Only 150 facilities (less than 1%) were identified by CMS as SFFs that were either newly added to the SFF list or had not shown improvement as of December 15, 2011.

Advancing Excellence in America’s Nursing Homes
Advancing Excellence is a voluntary quality improvement initiative implemented by the nursing home industry and others in October 2006.   When Advancing Excellence was implemented in 2006, facilities chose at least three goals from among eight available goals. Four goals were clinical goals – reducing high risk pressure ulcers, reducing the use of daily physical restraints, improving pain management in long-stay residents, and improving pain management in short-stay residents.  Four goals were non-clinical – setting individualized quality improvement targets; assessing resident satisfaction, family satisfaction, or both; measuring and reducing staff turnover; and consistent assignment of staff to residents.

Participation in Advancing Excellence has neither prevented nursing facilities from being identified as SFFs nor helped them improve the quality of care they provide to residents so that they are removed from the SFF list.  SFFs are defined as among the 1% of worst performing nursing facilities in the country, yet they participate in Advancing Excellence at high rates. Many facilities appear to have participated in Advancing Excellence when they were first identified as SFFs. Participation in the Campaign clearly has not improved their performance.
These findings give little reason to believe that Advancing Excellence is making a difference in improving quality of care and quality of life for residents. And they provide no reason to believe that voluntary quality improvement campaigns can be a substitute for an independent, objective, public regulatory system

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