Using secondary data, an analysis was done of the prevalence of inappropriate clinical care among 3,149 Virginia Medicaid nursing home residents. Six types of inappropriate care were examined: the un derprovision of skilled nursing care, physical reha bilitation and routine medical care; and the overuse of psychotropic drugs, physical restraints and uri nary catheterization. Thirty-two (32) percent of the residents received inappropriate care in at least one care area and 7% received inappropriate care in two or more areas. Residents who received the most in appropriate care were more dependent in their ac tivities of daily living, uncommunicative, inconti nent, likely to have had a stroke, and less disruptive. Residents who received the most inappropriate care are among the most vulnerable residents, and stronger regulation and outside advocacy may be needed to protect them from inappropriate care.
Get full access to this article
View all access options for this article.
References
1.
Kane RL, Kane RALong-Term Care: Principles, Programs and Policies. New York, Springer Publishing, 1987 .
2.
US Congress, Office Of Technology Assessment (OTA).Losing a Million Minds: Confronting the Tragedy of Alzheimer's Disease and Other Dementias (OTA-BA-323). Washington DC, US Government Printing Office, 1987.
3.
Institute of Medicine of the National Academy of Sciences (IOM).Improving the Quality of Nursing Home Care. Washington, DC, National Academy Press , 1986.
4.
Holmes D., et al.National Study of Levels of Care in Intermediate Care Facilities (ICFs): Excerpt Summary (DHEW Contract No. HSA-105-74-176). New York, Community Research Applications, 1976.
5.
Manton KG, et al.An analysis of the heterogeneity of United States nursing home patients. J Gerontol1985 ;40:34-46.
6.
US General Accounting Office (GAO).Medicare and Medicaid: Stronger Enforcement of Nursing Home Requirements Needed (GAO/HRD-87-113) . Washington, DC, US General Accounting Office, 1987.
7.
Moss FE, Halamandaris VJToo Old, Too Sick, Too Bad: Nursing Homes in America. Germantown, MD, Aspen Systems Corporation, 1977.
8.
National Center For Health Statistics.The National Nursing Home Survey: 1985 Summary for the United States (DHHS Publication No. (PHS) 89-1758). Washington, DC, National Center For Health Statistics, 1989.
9.
Gordon WZ, et al.Acute hospitalization in a home for the aged. J Am Geriatr Soc1985;33:311-326.
10.
Gillick M., Steel K.Referral of patients from long-term to acute-care facilities. J Am Geriatr Soc1983;31:74-78.
11.
Gustafson DH, Zimmerman D.The Potential for Incentives to Improve Quality of Care in Nursing Homes . Paper prepared for the Institute of Medicine Committee on Nursing Home Regulation, Fredericksburg, VA, November 1984.
12.
Gabow PA, et al.Comparison of hospitalization between nursing home and community residents. J Am Geriatr Soc1985;33:524-529.
13.
Jones EW, et al.Assessing the Quality of Long-Term Care (National Center For Health Services Research. Research Summary Series). Hyattsville, MD, National Center for Health Services Research, 1978.
14.
Brown NK, Thompson DJNontreatment of fever in extended-care facilities. N Engl J Med1979;300:1246-1250.
15.
Kayser-Jones JSDistributive justice and the treatment of acute illness in nursing homes. Soc Sci Med1986;23:1279-1286.
16.
Miller MB, Elliott DFErrors and omissions in diagnostic records on admission of patients to a nursing home. J Am Geriatr Soc1976 ;24:108-116.
17.
Miller WR, et al.External peer review of skilled nursing care in Minnesota. Am J Public Health1976;66:278-283.
18.
Zimmer JGMedical care evaluation studies in long-term care facilities. J Am Geriatr Soc1979;27:62-71.
19.
Kahn KA, et al.A multidisciplinary approach to assessing the quality of care in long-term care facilities. Gerontologist1977;17:61-65.
20.
Zimmer JG and Watson NMPhysician response to notification of acute problems in nursing homes. J Am Geriatr Soc1991;39:348-352.
21.
Kayser-Jones JSFactors contributing to the hospitalization of nursing home residents. Gerontologist1989;29:502-510.
22.
Zimmer JG, et al.Nursing homes as acute care providers. A pilot study of incentives to reduce hospitalizations. JAm Geriatr Soc1988;36:124-129.
23.
Willemain TR , Mark RBThe distribution of intervals between visits as a basis for assessing and regulating physician services in nursing homes . Med Care1980;18:427-441.
24.
Lee YSResults of an outcome oriented survey. Human Resources Admin1984;7:32-60.
25.
Shaughnessy PW , et al.An Evaluation of Swing-Bed Experiments to Provide Long-Term Care in Rural Hospitals. Vol 2, Final Technical Report. Denver, CO, University of Colorado Health Sciences Center, Center for Health Services Research, 1980.
26.
Becker G., Kaufman S.Old age, rehabilitation and research: a review of the issues. Gerontologist1988;28:459-468.
27.
Thorburn P., Meiners MRNursing Home Patient Outcomes: The Results of an Incentive Reimbursement Experiment. Washington, DC, National Center For Health Services Research, 1984.
28.
Toseland RWRehabilitation and discharge: the nursing home dilemma. Long-Term Care and Health Serv Admin Q1979;13:284-300.
29.
Murtaugh CM , et al.Nursing home reimbursement and the allocation of rehabilitation resources. Health Serv Res1988;23:467-493.
30.
US Department Of Health, Education, and Welfare, Office of Long-Term Care.Physician's Drug Prescribing Patterns in Skilled Nursing Facilities (Long-term Care Facility Improvement Campaign, Monograph No. 2). Rockville, MD, US Department Of Health, Education, and Welfare, Office of Long-Term Care , 1976.
31.
Beardsley RS, et al.Prescribing of psychotropics in elderly nursing home patients. J Am Geriatr Soc1989 ;37:327-330.
32.
Beers M., et al.Psychoactive medication use in intermediate-care facility residents. JAMA1988;260:3016-3020.
33.
Buck JAPsychotropic drug practice in nursing homes. J Am Geriatr Soc1988;36:409-418.
34.
Harrington C. , et al.Psychotropic drug use in long-term care facilities: a review of the literature. Gerontologist1992;32: 822-833.
35.
Garrard J., et al.Evaluation of neuroleptic drug use by nursing home elderly under proposed medicare and medicaid regulations. JAMA1991;265:463-467.
36.
Evans LK, Strumpf NETying down the elderly, a review of the literature on physical restraint . J Am Geriatr Soc1989;37:65-74.
37.
Dubay LC, Cohen J.The Effects of Cost Containment and Ownership on Nursing Home Costs, Casemix and Staffing (Urban Institute Working Paper #3585-02). Washington, DC, Urban Institute, October 1988.
38.
Ribeiro BJ, Smith SREvaluation of urinary catheterization and urinary incontinence in a general nursing home population. J Am Geriatr Soc1985;33:479-481.
39.
Ouslander JG , et al.External catheter use and urinary tract infections among incontinent male nursing home patients. J Am Geriatr Soc1987;35:1063-1070.
40.
Flagle CD, et al.Health Services in Long-Term Care (USPHS Grant No. 5-R18 HSO1250). Baltimore: Johns Hopkins University, 1977.
41.
Arling G., et al.Public Policy Series, Number 8: Study of the Virginia Medicaid Nursing Home Reimbursement System (Revised). Report submitted to the Department Of Medical Assistance Services, Commonwealth of Virginia , Richmond, VA, June, 1986.
42.
Jackson MM, Fierer J.Infections and infection risk in residents of long-term care facilities: a review of the literature, 1970-1984. Am J Infect Control1985;13:63-77.
43.
Ouslander JG , et al.Urinary incontinence in elderly nursing home patients. JAMA1982;248:1194-1198.
44.
Warren JWAcute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study. J Infect Dis1988;158:1341-1345.
45.
US Department of Health and Human Services, Health Care Financing Administration.State Operations Manual and Interpretative Guidelines for Skilled and Intermediate Care Facilities (HCFA Publication 7). Washington, DC, US Department of Health and Human Services, Health Care Financing Administration , 1989.
46.
Tinetti MA, et al.Mechanical restraint use among residents of skilled care facilities: prevalence, patterns and predictors. JAMA1991;265:468-471.
