1. Rhonda Richards AARP

2. 2 Nursing Home Quality  Quality of care and quality of life  Improvements since OBRA ’87  Still progress to be made AARP Government Relations & Advocacy June 5, 2008

3. 3 Nursing Home Quality Issues Include  Poor performing facilities and “yo-yo” facilities  Lack of sufficient staff for quality and continuity of care  Lack of accurate staffing data  Need for greater accountability and transparency  Need for improved quality measures  Need for better transitions across settings AARP Government Relations & Advocacy June 5, 2008

4. 4 How Does Ownership Impact Quality?  New York Times Sept. 2007 article found that private investor owned nursing homes: ► Cut expenses and staff; ► Scored worse than national rates in 12 of 14 quality indicators; and ► Created complex corporate structures obscuring who controlled them & who is ultimately responsible for quality of care AARP Government Relations & Advocacy June 5, 2008

5. 5 How Does Ownership Impact Quality?  Complex ownership structures can make it more difficult to hold facilities accountable  More research is needed to determine the relationship between private equity ownership and quality  Quality problems occur regardless of ownership – quality is broader than just ownership AARP Government Relations & Advocacy June 5, 2008

6. 6 Nursing Home Transparency and Improvement Act (S. 2641)  New ownership reporting and auditing requirements  More and better information on Nursing Home Compare about facilities and their performance  Reporting of staffing information based on payroll data; better Medicare data on spending for staff and services  Complaint resolution process and standard complaint form AARP Government Relations & Advocacy June 5, 2008

7. 7 Nursing Home Transparency and Improvement Act (S. 2641)  Improvements regarding civil monetary penalties  Smoother resident transition when facilities close  National independent monitoring program – interstate and large intrastate chains  Demonstration projects on culture change and use of IT in facilities AARP Government Relations & Advocacy June 5, 2008

8. 8 Other Ideas and Solutions Include  Steps to address poor performing nursing homes – such as ways to identify them earlier and prevent future quality problems  Workforce issues – sufficient staff, higher wages, improved benefits, greater respect, training and educational opportunities, safer working conditions, reducing turnover AARP Government Relations & Advocacy June 5, 2008

9. 9 Other Ideas and Solutions Include  Expansion of successful culture change efforts and encouraging greater resident choice and control  Greater coordination across care transitions – IT could be part of this  Better quality measures AARP Government Relations & Advocacy June 5, 2008