News reports relating to nursing homes most often concern adverse events that result in the avoidable deaths of residents. These can misrepresent the good work many nursing homes do. So, in order to put these unfortunate events into context, we have compiled a selection of nursing home statistics you should know.
According to the American Association of Retired Persons (AARP), 76 percent of Americans aged fifty and over would prefer to stay in their homes as they grow old. Unfortunately, the reality is that the majority of us will require some form of long-term care outside the home before we meet our maker - the progression of care most often being: home health care > assisted living facility > nursing home.
In the United States approximately 1.3 million citizens live in nursing homes, of which more than 15,600 participate in the Medicare and Medicaid programs. These are certified by the Centers for Medicare and Medicaid Services (CMS), who conduct inspections every nine-to-fifteen months to ensure standards are upheld, or to investigate issues reported by the nursing home or a member of a resident's family.
It is not unusual for CMS inspectors to find issues during scheduled inspections. The national average of citations per inspection is 5.7 (excluding isolated issues resulting in minimal harm), which implies there are almost 90,000 adverse events each year. However, because of the way in which citations are graded, it is possible to determine only 3.2 percent of issues result in actual harm or place residents in danger.
The CMS Citation Scale for Nursing Homes
The CMS citation scale for nursing homes runs from A (least severe) to L (most severe) according to whether issues are isolated, form a pattern, or are widespread. The most recent analysis of inspection reports reveals the most common issues are usually isolated environmental or care safety deficiencies with the potential to cause more than minimal harm but not resulting in actual harm:
|Percentage Distribution of Nursing Home Deficiencies|
|Source: HHS (PDF)||Isolated||Pattern||Widespread|
|Immediate Jeopardy||J = 0.3%||K = 0.4%||L= 0.2%|
|Actual Harm||G = 2.0%
||H = 0.2%
||I = 0.0%
|Greater than Minimal Harm||D = 55.2%||E = 28.6%||F = 8.2%|
|Minimal Harm||A = N/A
||C = 2.7%
When issues are identified, CMS inspectors have several courses of action available to them. The most common resolution is a Plan of Correction, while Civil Monetary Penalties are only issued for deficiencies in Category G and above. States can issue their own fines - the level of which varies by state - and CMS can withhold Medicare and Medicaid payments or disqualify the facility from the healthcare programs.
The base scale of Civil Monetary Penalties is relatively small - ranging from $250 per instance per day for a Category G deficiency, to $5,500 per instance per day for a Category L deficiency. However, the base scale can be increased if there is a history of noncompliance with previous Plans of Correction, repeated deficiencies within the same Category, or a general substandard quality of care.
There Have Been Some Large Fines Issued
The website prorepublica.com maintains a “Nursing Home Inspect” tool, using which it is possible to identify nursing homes with the most citations and highest Civil Monetary Penalties. The results imply CMS standards and fines for deficiencies are not applied consistently nationwide - or that nursing homes in certain states are particularly negligent. From the database, you can see the number of offensives and fines such as the top ten here:
|Nº of Deficiencies Recorded since 2011||Highest Rated Deficiency||Total Amount Fined since 2011||Medicare/ Medicaid Payments Suspended|
Putting Nursing Home Statistics into Context
If you multiply the average number of citations per CMS inspection (5.7), by the number of certified nursing homes (15,600) you arrive at the total number of citations per year (88,920). We know from the table above that 3.2 percent of deficiencies result in actual harm or place residents in danger, and 3.2 percent of 88,920 is 2,845 adverse incidents per year out of a nursing home population of 1.3 million.
This means a nursing home resident has a 1-in-457 chance of being injured or placed in danger due to an environmental or care safety issue, which - compared to life outside a nursing home - isn't bad odds. According to online insurance firm esurance.com, there is a 1-in-366 chance of being injured in an automobile accident for every 1,000 miles traveled.
Therefore, despite click bait headlines and significant Civil Monetary Penalties for isolated incidents, our nursing home statistics demonstrate residents are generally in safe hands and well cared for. Avoidable adverse events can happen with unfortunate consequences; but, in general, nursing homes are much safer, caring environments than they are sometimes made out to be.
How Technology Can Help Nursing Home Staff Stay Focused on Patient Safety
Staffing call outs, severe weather, influx of patient activities, all of these elements can have an impact on nursing home staff. And communication is key during all of these critical events. A mass notification system equipped to not only communicate these events but solicit feedback such as staff available to cover shifts, could truly make a difference.