Saturday, February 16, 2008
Why nursing homes have poor quality
I was thinking about this last night and realized something quite obvious. JCAHO, the organization that accredits virtually every hospital in this county, has established standards for hospitals to go by. These standards are considered optimally achievable outcomes -- what a facility should aspire to be. CMS standards, the ones that nursing homes are required to comply with, are minimum standards -- the absolute bare minimum you can do to get by with. Literally every single nursing home I have worked with has regarded the CMS minimum standards as optimal achievable outcomes. The prevailing thought in the long term care industry is that a deficiency free survey is something you should aspire to. The problem with this thinking is that a deficiency free survey only means that you are providing a minimally acceptable level of care. Facilities must truly desire to go above the minimum standards, which requires blowing up the box and getting the hell away from the status quo. Unfortunately this is too scary for most providers and corporate owners. Nursing homes have the worlds worst case of "we have never done it this way before" that anyone has ever seen.