2008 Nursing Residents' Data

Steve Gold's Information Bulletin # 270 (12/08) The 2008 Nursing Home Data Compendium is now available (with 2007data), and it provides useful information for disability advocates. CMS collects this data primarily from two sources - the Minimum Data Set (MDS)(data provided quarterly for each nursing home resident from nursing homes) and from OSCAR (data collected from CMS's own surveys and certifications). Also, all of this data is available in this Compendium by state. 1. Why are people in facilities? A. ADL Impairments: Nearly 29% of persons in nursing facilities had NO Activity of Daily Living impairment; that's more than 930,840 people institutionalized at sometime during 2007 who had no ADL impairments. Another 8.1% (260,893)had only one ADL Impairment. (Table 3.3.(e)) The following states had the largest percentage of persons in nursing facilities who had NO ADL Impairments: IL, OK, MO, KS, LA, AR. The following states had the largest percentage of persons in nursing facilities who had only one ADL Impairment: RI, NH, IO, ND, WI, CT and MN. Why are any persons in nursing facilities with so few ADL Impairments? Why are States (and CMS) permitting these people to be admitted into nursing facilities and then paying Medicaid for them to be unnecessarily institutionalized? Why aren't advocates making the States "Close the Front Door" and not admit or pay for these persons, or at least, offer them services in the community? Even assuming that at time of admission they had multiple ADL impairments, when they no longer have them these individuals should be offered appropriate services in the community. This does not seem like a difficult task for your state. B. Cognitive Impairments: Nearly 31.4% of residents had NO Cognitive Impairment; that's more than886,749 persons without any cognitive impairments. Another 12.2%(390,025) had only a very mild cognitive impairment. 58.2% had a mild or less cognitive impairment. (Table 3.5(3)) The following states had the largest percentage of persons with NO Cognitive Impairments: AZ, NJ, FL, DC, NV, and MD Our questions: Again, why are these persons in nursing facilities,especially since many/most persons with cognitive impairments also have ADL impairments? When one looks at both ADL and Cognitive Impairments together, a frightening picture emerges. Have nursing facilities become the last refuge for many persons who are primarily, homeless,developmentally disabled, mentally ill? Why is your State (and CMS) wasting Medicaid funds dollars on those persons who could easily be treated less expensively for in the community? 2. How are People Doing in Nursing Facilities? Many of the following are life threatening conditions. Many are actually caused by the nursing facilities' inadequate and improper treatment. They all demonstrate that people are at significant risk when they enter a nursing facility. A. Pressure Ulcers (only if the pressure sore was at stage 2 or greater,and does not include stage 1 pressure sores)(Table 3.7 and 3.9). They are associated with increased mortality and often require aggressive (and expensive) medical and surgical therapy. Prevention requires regular turning, eliminating focal pressure, and keeping the skin dry. i. Nationally, half of all nursing facilities (the median) had more than7.8% of its residents with these pressure ulcers. ii. The following States had the highest percentages of nursing facilities (90th percentile) with residents who had stage 2 or greater pressure ulcers: DC, CA, MD, NJ, NV, VA, and PA. (Table 3.7). iii. The following States had the highest incidence of pressure ulcers which occurred while the residents were entirely under the care of the nursing facility, i.e., they did not have these ulcers on admission: IN,KY, DC, PA, and WY. (Table 3.9) B. Use of Physical Restraints (whether trunk restraint, limb restrain or some sort of restraining chair): i. Nationally, half of all nursing facilities (the median) had more than2.3 % of its resident who were put in physical restraints. ii. The following States had the highest percentages of facilities (90th percentile)with residents in such physical restraints: LA, CA, AR, OK, MS,NV, TN, and NM. (Table 3.11). C. Tube Feeding (The following data excludes persons admitted who had feeding tubes at time of admission.) (Table 3.15): i. Nationally, more than half the nursing facilities (the median) had 3.2% of their residents who had feeding tubes. ii. The following States had the highest percentages of facilities (90th percentile) with residents who were put on feeding tubes: HI, DC, CA, NV,MS, AK, and KY. D. Weight Loss (i.e., more than 5% weight loss in the last 30 days or more than 10% in last 180 days, and data excludes residents with end-stage disease or receiving hospice care): i. Nationally, half of all nursing facilities (the median) had more than7.7% of its residents had such weight loss. ii. The following States had the highest percentages of facilities (90th percentile) with residents who had such weight loss: OR, NV, WY, HI, WA,VA. (Table 3.17). E. Severe Bladder or Bowel Incontinence (Nor episodic but on almost all occasions, and therefore an indication of severe incontinence): i. Nationally, half of all nursing facilities (the median) had more than32.7% of its residents had severe bladder or bowel incontinence. ii. The following States had the highest percentages of facilities (90th percentile) with residents who had severe bladder or bowel incontinence on almost all occasions: HI, CA, SC, DC, SC, NV, VA, GA. (Table 3.19). 3. Nursing Facility Deficiencies A. Only 8% of the states' nursing home surveys had ZERO health deficiencies' citations. (Table 4.5.(e)). The following states had the most health deficiencies cited: RI, MA, PA,.OR, NH, NV. B. 17.1% of all states' nursing facilities had surveys which recorded a health deficiency of "actual harm or immediate jeopardy to residents."(Table 4.8.(e)) The following states had the most health deficiencies of"actual harm or immediate jeopardy to residents": CO, CT, DC, DE, ID, MI,,WI ,WY, NE, NM.. 4. Specific Nursing Facility Deficiencies: A. Nearly 18.3% of all states' nursing facilities had surveys resulting in a citation for failure to treat or prevent pressure ulcers, but there was a wide spread among the states. (Table 4.18.(e)). What follows is the percent of all nursing facilities by state that we recited for "Failure to Treat or Prevent Pressure Ulcers." Alabama 17.0% Alaska 5.3% Arizona 17.1% Arkansas 46.9% California 19.8% Colorado 20.3% Connecticut 34.5% Delaware 29.8% D. C. 28.6% Florida 10.3% Georgia 17.6% Hawaii 10.3% Idaho 28.8% Illinois 21.5% Indiana 26.4% Iowa 17.5% Kansas 38.1% Kentucky 11.5% Louisiana 16.8% Maine 16.2% Maryland 9.0% Massachus 8.5% Michigan 19.4% Minnesota 62.4% Mississippi 5.9% Missouri 26.6% Montana 14.5% Nebraska 21.9% Nevada 10.9% New Hamp 7.4% New Jersey 14.8% New Mexico 13.9% New York 17.7% North Carolina 6.6% North Dakota 7.7% Ohio 20.5% Oklahoma 12.1% Oregon 12.8% Pennsylvania 8.8% Rhode Island 9.3% South Carolina 22.2% South Dakota 4.6% Tennessee 8.0% Texas 10.6% Utah 3.7% Vermont 16.2% Virginia 20.0% Washington 23.7% West Virginia 5.4% Wisconsin 18.8% Wyoming 15.4% National 14.7%