Nursing CE Central
On February 21st, Ohio launched a new nursing home quality navigator. This innovative online tool allows residents and nurses insight into the inner workings of nursing homes across the state.
The navigator provides transparency and accountability for nursing homes, which has been a priority at the state and federal levels. Nursing homes have faced increased scrutiny over financial priorities and patient safety.
Ohio’s nursing home quality navigator is part of the state’s overall mission to improve the quality of life for senior patients and is a step towards standardizing safe staffing ratios and creating accountability when determining a patient’s care needs.
Funding for this navigator was part of a $40 million state initiative to support services for patients aged 60 and older in Ohio. The funding from this bill went into effect in July of 2023.
This article will outline the navigation tool and the information it can provide, as well as the quality measures nursing homes are being graded on and how Ohio is working to support nursing homes in reaching those measures.
The nursing home quality navigator allows users to see nursing homes within a radius of their location. From there, users can filter by whether the facility accepts Medicare/Medicaid, what federal star rating the facility has from CMS, and if the facility is for-profit or nonprofit.
Alongside these filters, additional information is provided for each home, including the number of beds in the facility, if the facility has been cited for abuse, and if it is a special focus facility. Special Focus Facilities (SFF) are identified by poor patient safety and are visited by surveyors twice as often as typical nursing homes.
Users can also select multiple nursing homes from the list and compare more detailed information, such as the average number of patients per day, the staffing score, the nurse turnover rate, and the total nurse hours per resident per day. The information is compared to the state average to help create a baseline in the user’s mind.
These metrics are innovative tools not only for potential patients but also for potential nursing staff, who can evaluate potential employers. Nurses can also see a detailed view of how many hours different types of nurses (such as RNs, LPNs, and nurse aides) work per resident per day.
The Ohio Department of Aging has released an instructional video showcasing the unique search tools available in the new navigator.
The Center for Medicare and Medicaid Services (CMS)Â rates nursing homes out of five stars. The star rating represents the overall quality based on health inspections, quality measures, and staffing.
Ratings are given based on data from the last three years of federal surveys, and then star ratings are given based on the ranking of the nursing home within the state. Health inspections are the first consideration when grading the quality of a nursing home and are re-graded each month to include any new survey results.
A 5-star rating is given to the top 10% of nursing homes in each state, 2, 3, and 4-star ratings are given to the next 70% of nursing homes (23.33% each), and 1-star is given to the bottom 20%.
There are ten quality measures nursing homes are graded one, three acute care measures, and seven long-term measures:
ADL and Mobility decline are weighted more heavily than the other care factors as these represent more serious interventions needed.
Star ratings for quality measures are awarded using the same proportion as health inspection ratings.
Staffing ratings are measured by the total number of RN hours per resident per day and the total nurse staffing hours (including RNs, LPNs, and nurse aids) per resident per day. This ensures that the rating represents a holistic nursing team for residents in long-term care facilities.
CMS only awards 5-star ratings on staffing to nursing homes that meet or exceed the latest staffing study thresholds for RNs and total nursing hours per resident per day.
The overall quality is not determined by averages of the scores of the previous three measures. Instead, facilities start with a baseline score determined by their health inspection rating.
If the staffing rating is 4 or 5Â stars and higher than the health inspection rating, one star is added to the overall quality. If the staffing rating is one star, a star is subtracted from the overall quality.
Quality measures only change the star rating in extreme cases. A 5-star rating adds a star to the overall quality, and a 1-star rating subtracts a star from the overall quality.
There are also star-maximums implemented. For example, a nursing home with a health inspection rating of 1 star cannot have more than a 2-star overall rating. Special focus Facilities cannot have an overall score of over 3 stars.
From these calculations, the final score for nursing homes surveyed by CMS is determined.
The nursing home quality navigator is only one of the initiatives Ohio is implementing through its Nursing Home Quality & Accountability Task Force. This task force made four key recommendations when prioritizing care for elderly patients: enabling excellence, ensuring oversight and accountability, empowering residents, and facilitating data-backed decisions.
Ohio recommends a variety of immediate actions to enable excellent care for nursing homes. These actions will help sustainably grow the nursing home workforce in Ohio and create data that can be used to address any barriers to entry.
The proposed actions include adding workforce staffing levels to existing Medicaid quality measures, developing resources to help nursing homes understand the quality and safety expectations they need to adhere to, asses where the nursing home staff talent supply is being produced, developing multilingual marketing campaigns for nursing home roles, and designing specific training for staff caring for patients with dementia or other disabilities from different cultural backgrounds.
To ensure oversight and accountability within nursing homes, Ohio wants to take a proactive approach to standardizing the expectations nursing homes are held to. This will also allow nursing homes to designate resources for improving on specific measures they know are being observed.
The immediate actions Ohio wants to take toward this goal are hiring more nursing home surveyors, creating a training program on the survey process, developing specific protocols that can be immediately deployed when needed during an on-site survey, and creating a web-based complaint platform for nursing home patients and their families to track the status of their complaints.
Patient care is the foremost concern in a nursing home, and there are several immediate actions Ohio would like to take to empower residents in long-term care facilities. Empowering residents and educating them on proper care will help identify any violations that need to be addressed and help them advocate for themselves.
The recommendations are consolidating existing long-term care resources into a single program, including resources for post-acute care, launching media campaigns for the general public to know the importance of advance care planning, implementing a nursing home orientation template that can be used when transitioning from acute care to a long-term care facility, and standardizing the training nurses receive when caring for patients with a disability or dementia.
All of the proposed changes to nursing home care need to be backed up by data. The state of Ohio wants this data to be accessible and public-facing to increase transparency for potential patients and staff members.
To create this data, they plan on taking the following immediate actions: collating data from multiple state departments, creating a public-facing dashboard, and collecting new data through real-time surveys of residents and their families.
This new tool is a breakthrough moment for improving care in nursing homes. By allowing the public access to standardized information empowers them to make informed decisions about where they want to live or work.
These informed decisions pressure nursing homes to prioritize patient safety and quality care by investing in their nursing workforce, hopefully creating a rising trend of improved care in Ohio.
Other states will hopefully follow Ohio’s lead and utilize the federal data provided by CMS to create initiatives to promote quality care in nursing homes, leading to improvements for nurses and patients across all long-term care facilities.Â
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