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1Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
LTC Issues Committee:
Nursing Home Report Card Update
July 24, 2007
Teresa Lewis
2Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Minnesota Nursing Home Report Card
• WHY:– Transparency to consumers– Provider benchmarking and quality improvement
• HOW:– Nursing homes selected by geographical areas– Facility assigned 1-5 stars on each of seven
dimensions
http://www.health.state.mn.us/nhreportcard/
3Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Minnesota NursingHome Report Card
Quality Measures - update frequency• Resident quality of life ratings - annually• Minnesota quality indicators - quarterly• Hours of direct care - annually• Staff retention - annually• Temporary staffing agency use - annually• Proportion of single rooms - quarterly• State inspection results – quarterly
4Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
User Priority ofQuality Measures
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Quality Measures
% S
elec
tin
g
10/06-1/07 82.9% 62.2% 64.0% 43.2% 24.1% 13.9% 9.5%
2/07-6/07 81.5% 62.5% 60.2% 43.7% 28.4% 16.1% 7.5%
Quality of Life
MDH Inspection
s
MDS Quality
Indicators
Staffing (HPRD)
Staff Retention
Single-Bed Rooms
Use of Pool Staff
5Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Report Card Usage
Unique Visitors to NH Report Card
0
500
1,000
1,500
2,000
2,500
Oct 06 Nov 06 Dec 06 Jan 07 Feb 07 Mar 07 Apr 07 May07
Jun 07
Major Report Card Updates
6Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
7Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Minnesota NursingHome Report Card
Enhancements being considered• Format• Drill down• Refine scoring of MDH measure• Add measures for family satisfaction,
environment• Add non-MA facilities• Enable special focus on areas such as short
stay, dementia• DHS is interested in developing report cards
for other provider types
8Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Quality of Life Trends
• 2007 data pending due to risk adjustment• Overall risk-adjusted resident satisfaction for
2006: 82% • High points in 2006
– Staff treating residents with dignity– Staff adapting environment to residents (significant ↑)
• Areas to target– Resident reports of negative emotions– Staff offering meaningful activities– Most quality areas had small but significant declines
’05 to ‘06
9Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Quality of Life TrendsSignificant Changes Using Paired T-Tests are Bolded
MN Average Risk-Adjusted Scores
Quality of Life Area 2005 2006 Difference
Dignity 96.5% 96.2% -0.3%
Environmental Adaptations 87.9% 88.2% 0.4%
Security 87.9% 86.7% -1.2%
Privacy 87.4% 86.4% -1.0%
Food Enjoyment 86.3% 84.8% -1.5%
Individuality 84.7% 84.2% -0.5%
Relationships 83.3% 81.9% -1.4%
Comfort 81.8% 81.9% 0.1%
Autonomy 83.6% 81.8% -1.9%
Satisfaction 83.7% 81.8% -2.0%
Overall Score 82.2% 81.7% -0.5%
Mood 69.7% 69.4% -0.2%
Meaningful Activity 68.2% 68.5% 0.3%
10Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Quality of Life TrendsChange in Risk-Adjusted QOL Scores
(2005 to 2006)
-2.0%
-1.5%
-1.0%
-0.5%
0.0%
0.5%
Significant Improvement
Significant Decline
11Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Quality of Life Update
• Interviews done Feb – May 2007• Over 14,000 valid surveys• NFs more satisfied with overall process
– 2005: 89%– 2006: 94%– 2007: 95%
• Anticipated result timelines:– Observed results were to NFs mailed in early July– Risk-adjusted results on Report Card in July
12Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Clinical Quality Indicators Trends
• 24 risk-adjusted care processes and outcomes
• Total change from 7/2004 to 12/2006– 20 QIs improved – Best: Pain, physical restraints, weight loss– Areas to target: Falls, burns/skin tears/cuts,
mobility
13Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Clinical Quality Indicators Trends
Total Improvement in Risk-Adjusted QIs (July 2004 - Dec 2006)
-0.01
0.00
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08 Significant Improvement
14Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Clinical Quality Indicators Update
• Psychoactive drug QIs now updated to reflect new clinical guidance
• 2006 Q1-4 QI report mailed to NFs in late June– Observed and risk-adjusted rates– Facility ranks compared to rest of state– Points received
15Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Risk Adjustment
• QoL/RS scores adjusted for resident age, gender, cognitive/physical status & LOS; facility location and average resident LOS
• QIs adjusted for resident age, gender, diagnoses, functional status, and health conditions
• Empirical Bayes estimates from multilevel models
16Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Direct Care StaffingTrends
Wage & Acuity-Adjusted Direct Care Staffing
4.744.22 4.49
5.23
4.264.73
0.00
1.00
2.00
3.00
4.00
5.00
6.00
Hospital Board and Care Standard
Provider Type
Hou
rs/R
esid
ent
Day
2004
2005
• Hospital and standard NFs significantly increased staffing ‘04 to ’05• Data needed for this measure was not collected in prior years
17Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Staff Retention TrendsStaff Retention
71.7% 72.2% 71.8%
0%
20%
40%
60%
80%
Oct 02 - Sept 03 Oct 03 - Sept 04 Oct 04 - Sept 05
• Retention has not changed significantly ’03 to ’05
All Direct Care StaffRNs, LPNs,
TMAs, CNAs
18Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Temporary StaffingTrends
Supplemental Nursing Staff for NFs Using Any
4.09%
2.75%2.50%
0%
1%
2%
3%
4%
5%
Oct 02 - Sept03
Oct 03 - Sept04
Oct 04 - Sept05
• NFs using no supplemental nursing staff:-- 236 (59%) in 2003 -- 252 (64%) in 2004 -- 268 (68%) in 2005
19Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Single-Bed Room Trends and Update
Percentage of Single-Bed Rooms
25.9%27.8% 29.4% 31.2%
0%
5%
10%
15%
20%
25%
30%
35%
Oct 05 Oct 06 Mar 07 July 07
20Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Old MDH Inspection Trends
Current MDH Inspection Measure
9.69 9.54 9.40 9.45 9.40 9.31
0
2
4
6
8
10
Jan 05 -Jan 06
Apr 05 -Apr 06
July 05 -July 06
Sep 05 -Sep 06
Dec 05 -Dec 06
Mar 06 -Mar 07
Sco
re (0-1
0)
• Scores have declined slightly over past year
21Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
MDH State Inspection Update
Stars Awarded 5 4 3 2 2 1
Criterion 1Most Recent
SurveyMet Met
Met with Single-G
Exception
Met with Single-G
ExceptionNot-Met Not-Met
Criterion 2Complaints
Met Met Met Not-Met Met Not-Met
Criterion 3Prior Survey
Met N/A N/A N/A N/A N/A
Criterion 4Special Focus
FacilityMet Met N/A N/A N/A N/A
Criterion 5Total
DeficienciesMet N/A N/A N/A N/A N/A
22Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
MDH State Inspection Update
237
59 56 45 20
50
100
150
200
250
5 4 3 2 1
Revised Measure Stars
# o
f N
Fs
23Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
MDH State InspectionUpdate
NF Stars UsingOld QM
(Mar 07 data)
NF Stars Using New QM (Apr 07 data)
***** **** *** ** * Total
***** 222 56 30 31 1 340
** 7 2 26 11 1 47
* 0 0 0 3 0 3
Total 229 58 56 45 2 390
24Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division
Questions?
Teresa LewisNursing Facility Rates and Policy Division
MN Department of Human ServicesPO Box 64973
St. Paul MN 55164-0973
Located at 540 Cedar St. in downtown St. Paul
Voice 651-431-4208 teresa.lewis@state.mn.us
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