Skilled Nursing Facility Care Report 2013 (AQNHC) – No Surprises

The Alliance for Quality Nursing Home Care released a new report, “Insights & Progress: A 2013 Quality Report on Skilled Nursing Facility Care” this week, which provides an analysis of care quality, key trends in quality, improvements that have been made and are underway as well as care areas that need continued attention for SNFs across the nation. The AQNHC Nursing Home Care report reviews Quality Measures, survey outcomes, staffing and rehospitalization rates. Continued improvements in these areas over the past few years have resulted in higher quality being provided to residents, and the Centers for Medicare & Medicaid (CMS) is bolstering these efforts with some of the key initiatives we have been blogging about for the past year.

Quality Measures

The AQNHC report shows that when reviewed under the MDS 3.0, nursing facilities improved in 13 of 15 quality measures in 2011-2012, with the exceptions being long stay incontinence and influenza immunization measures. For pain quality measures, short stay quality measures decreased from 24% to below 23%, and long stay also showed improvement, with the rate decreasing from around 14% to 12%. CMS released updated Quality Measures for MDS 3.0 in April, which should continue provide a continued focus on getting better scores in some of these areas. The national initiative to reduce pressure ulcers, has helped the lower the rates of both short stay and long stay pressure ulcers in 2011-2012 as well. The report also shows a decline in the use of physical restraints for the same time period.


As we are all aware, hospitals are being penalized for some readmissions, and skilled nursing facilities may be next on the list. The report shows a gradual decline from 2007 (21.6%) to 2011 (20.9%). With the emphasis being placed on reducing readmissions, this number should continue to trend downward in coming years.

Survey Outcomes

We’ve been noting for several years at conferences and education sessions that there is significant variance to the scope and severity of identified issues during survey by state/region. This report reviews the time period from 2003-2011 and shows the average number of F-tags given on a survey in 2003 as 5.9, peaking in 2007-2008 at 7, and then going down slightly to 6.1 in 2011. The percentage of these deficiencies that were considered substandard quality of care follows a similar curve, starting at 5.3% in 2003, spiking at 7.4% in 2008 and slowing bottoming out to 6.4% in 2011. Starting in 2009, these numbers started to come down across the country.


For the review period of 2003-2011, the average number of nurse aide and licensed nurse hours increased, whereas the percentage of contracted staff decreased. This report states that while many quality initiatives have been put in place regarding staffing, overall there has been a decline in headcount at SNFs in the past years. This is attributed to major funding reductions in the Medicare and Medicaid programs, with a large loss occurring between October and November 2011 when an 11.1% reduction in Medicare payments to skilled nursing facilities was made.

Consumer Satisfaction

The skilled nursing facility satisfaction surveys conducted that are outlined in this report focus on quality of life, quality of care and quality of services provided for long stay residents. The results show that 88% of residents and their family members have high levels of satisfaction with the care being provided in these areas and would recommend the facility to someone else in need of services. The two most important areas where these people were concerned with were related to the investment in care provided by the staff as well as the competency of the staff. CMS is reinforcing the staff’s level of care with an increased focus on getting the staff involved in initiatives like QAPI, as well as the focus on interviews in the QIS.

Employee Satisfaction

As mentioned above, the staff is very important to residents and their families, as they ensure that a high quality of care is provided. The report shows a correlation between facilities that have a high level of satisfaction with their staff and resident/family satisfaction. Skilled nursing facility employees rated a sense of accomplishment as the most important aspect of their satisfaction, followed by respectfulness of other staff, and the safety of the facility.


Resident-Centered Care Does Matter

We recently noted in our post, “The Expanding Focus on Resident-Centered Care in Nursing Homes” that CMS and the OIG are targeting quality improvement related initiatives with the projects such as the roll-out of the Quality Indicator Survey nationally, the requirement that facilities implement a QAPI Plan, as well as the OIG’s review of how RAI instruments are being developed and MDS data is being used to ensure residents are receiving the highest quality of nursing home care. The AQNHC report on skilled nursing facility quality of care reflects the focus of these and other initiatives to ensure the highest level of care is being provided to residents in these facilities.

To read the Alliance for Quality Nursing Home Care 2013 Report, visit the AQNHC website.

To read the press release, “Analysis of U.S. Nursing Home Care Quality Details Continuing Progress for Patients,” click here.

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