Editor's Note: Senior housing and services providers will enter 2015 with many unanswered questions regarding their future. A new Republican majority in the U.S. Senate, an expanded Republican majority in the U.S. House of Representatives and the presence of Republican governors in more states will bring new perspectives to the political landscape. Controversial presidential executive orders related to immigration reform await resolution, and threatened governmental action could overturn some or all of the Affordable Care Act and the health insurance it provides to certain seniors and others. New payment models and regulations under consideration could alter the business climate for years to come. In a multi-part series, Long-Term Living takes a look at some of the top issues that those who serve older adults will face in the new year. This is part three. See the entire series here, or see the digital edition of the December 2014 issue for the print version of these and related articles.
The goal of reducing the off-label use of antipsychotic medication in nursing homes was one of the most visible efforts to ensure quality among aging services providers in 2014, and those efforts will continue into 2015 and beyond.
The public/private National Partnership to Improve Dementia Care, counting among its members AMDA‒The Society for Post-Acute and Long-Term Care Medicine, the American Health Care Association (AHCA), LeadingAge and Advancing Excellence in America’s Nursing Homes, in September announced a new goal to reduce the use of the drugs in residents by 25 percent by the end of 2015 in relation to a baseline rate from the fourth quarter of 2011. The new goal builds on previous reductions and anticipates additional reductions in 2016.
“We have a number of our members who have made commitments to be [at a] zero use rate for antipsychotics,” says Cheryl Phillips, MD, LeadingAge’s senior vice president of public policy and advocacy, who is immediate past co-chair of Advancing Excellence. “Can every nursing home do that? No, because there are some indications for these medicines, but not at the levels that have been used across the country. We think the 25 percent is very doable. ...and we recognize this as a key measure for quality.”
Providers that focus on person-centered care and train those who work with those who have cognitive impairments reduce the need for medication management for dementia “dramatically,” Phillips says.
AHCA Chair Len Russ also is a proponent of the ability of training to support quality-related efforts. He is immediate past vice chair of the Foundation for Quality Care, a New York-based organization that operates in conjunction with the New York State Health Facilities Association. The foundation, he says, has used state and federal grants to “upgrade” the skill sets of nurses, nurse managers and social workers in an effort to improve continuity of care, reduce rehospitalizations and better manage acute or post-acute comorbidities. (AHCA has its own quality initiative, too. [PDF])
Beginning in January, rehospitalization rates and the off-label use of antipsychotic drugs will be two new additions to the Centers for Medicare & Medicaid Services’ calculations of the five-star ratings featured on its Nursing Home Compare website. The addition of those measures was part of the presidential executive order announced in conjunction with the signing of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 in September.
The IMPACT Act and accompanying executive orders will be a major force in the quality efforts of senior housing and services providers moving forward, says Clif Porter, senior vice president of government relations for AHCA. The act “essentially says, ‘We want to measure quality; we want to define indicators that are important and comparable,’ ” he says. “It defines what those measures will be, and then it shines a light on providers’ results in those measures and compares them.”