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2015
QUALITY
UPDATE
California Skilled-Nursing & Rehabilitation Facilities
Executive
Overview
In 2010, more people were
65 years or older than in any
other previous census.
Most of them will need an
average of three years of
long-term care services.*
WOMEN
3.7 years
MEN
2.2 years
A recent report by the U.S. Department of Health and Human Services
contained a revealing statistic – people who are turning 65 years of age will
need an average of three years of long-term care services at some point in
their lives. While some 65-year-olds may never need long-term care, 20
percent will need it longer than five years.
With 1,100 people turning 65 each day in California, that’s a compelling
reminder of the importance of long-term care and the ability to deliver
services to residents where they need it – whether in the hospital, the
community, at home or in skilled-nursing centers.
Members of the California Association of Health Facilities provide costeffective, high-value, 24-hour skilled-nursing care to 300,000 residents each
year – as a result, 80 percent are discharged within three months.
As we help people return back home, we do so with a single purpose:
to deliver dependable, quality care with an emphasis on attaining the highest
practical level of functioning for the individual.
This report outlines some of our performance achievements.
20% will need long-term
care for more than 5 years.
California providers continue to lead the nation in five quality measure
categories:
•
Reducing depression
•
•
•
•
Reducing urinary tract infections
Preventing a decline in activities
Preventing falls with injury (second in nation)
Preventing weight loss (second in nation)
These accomplishments, and others outlined in this report, reflect the
commitment of 135,000 long-term caregivers to coordinate care, reduce
unnecessary hospital readmissions and transition residents to the most
appropriate setting based on their needs.
As we measure our progress compared to other states, we remain mindful of
our responsibility to address the unique needs and challenges of each of our
residents so they can experience satisfaction, wellness and quality of life.
James H. Gomez
CEO/President
CALIFORNIA
ASSOCIATION OF
HEALTH FACILITIES
2
* U.S. Department of Health and Human Services
Measuring Up
Unprecedented Transparency
No other health care entity is more regulated than skilled-nursing
facilities. Licensed by the California Department of Public Health
(CDPH) and certified to provide services to eligible Medicare and
Medicaid beneficiaries, skilled-nursing centers are required to maintain
compliance with federal regulations. The CDPH enforces both state and
federal regulations through unannounced annual surveys and complaint
investigations.
One component of the Nursing
Home Compare website is the FiveStar Quality Rating system. The
rating, which is issued quarterly, is
based on a combination of factors
including nursing home:
•
•
•
Health inspections
Staffing
Quality measures
Consumers seeking to learn about a particular skilled-nursing facility
have access to an enormous amount of web-based information on
Nursing Home Compare. The federal Centers for Medicare & Medicaid
Services (CMS) tracks:
Almost two-thirds of all skillednursing home in California – 63
percent – have 4 or 5 star ratings
• Five-Star ratings
•
Inspections and complaints over the last three years
•
Staffing – hours of care per resident
•
Quality measures
•
Penalties
Star Rating
During a standard survey, a team of surveyors assesses a facility’s
performance on more than 500 areas of care.
Percent of
Facilities
40%
23%
15%
National Leaders in Delivering Quality
Nursing home quality is determined by a performance evaluation of
18 separate quality measures including the presence of pain, pressure
ulcers and whether residents have received pneumonia and influenza
vaccinations. California facilities lead the nation in a number of
categories.
QUALITY MEASURE
Preventing a decline in activities
Preventing depression
Preventing urinary tract infections
Preventing weight loss
Preventing falls with injury
Use of antipsychotic medications
in short stay residents
Controlling pain in long-stay residents
19%
3%
CALIFORNIA
RANKING
#1
#1
#1
#2
#2
#3
#4
Enriching Lives
Hundreds of families turned
out for the annual Warm Coat
Giveaway in Richmond in
December. The family-owned
Shields Nursing Centers have
donated new coats to youths
every year since 2009.
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National
Quality
Initiative
In 2012, the federal government
turned the spotlight on
the practice of prescribing
antipsychotic medication to
nursing home residents suffering
from dementia. With a goal of
improving the quality of care
provided to these individuals, the
Centers for Medicare & Medicaid
Services initiated the National
Partnership to Improve Dementia
Care in Nursing Homes. The
national goal called for providers
to safely reduce the unnecessary
use of antipsychotic medication by
15 percent by December 2013.
In California, the goal was
reached.
Skilled-nursing providers in
the state have worked hard to
reduce the use of these drugs
even further, and today only 1
in 6 nursing home residents are
prescribed antipsychotics by their
physician.
California providers have
performed better than most
of the nation in reducing the
unnecessary use of antipsychotics.
Decrease in Use
of Antipsychotics
United States California
4
19.4%
28%
Established by our national affiliate, the American Health Care Association,
the National Quality Initiative builds on existing work in the long-term care
field by setting specific, measurable targets to further improve quality of care
in America’s skilled-nursing centers.
Safely Reduce the Off-Label Use of Antipsychotics: By December 2013,
reduce the off-label use of antipsychotic drugs by 15 percent. California
achieved this goal in 2013.
Why this is important: Using antipsychotics to treat behavior
associated with dementia is not supported clinically and use of the drugs
increases the risk of death.
Safely Reduce Hospital Readmissions: By March 2015, reduce the number
of hospital readmissions within 30 days during a skilled-nursing stay by 15
percent.
Why this is important: Hospitalization is disruptive to elderly
individuals and places them at greater risk for complications and infections.
Increase Staff Stability: By March 2015, reduce turnover among nursing staff
(RN, LVN, CNA) by 15 percent.
Why this is important: Research shows that happy and satisfied staffs
provide better quality care and contribute to greater quality of life for nursing
home residents.
Increase Customer Satisfaction: By March 2015, increase the number of
customers who would recommend the facility to others up to 90 percent.
Why this is important: Facilities with the highest rates of satisfaction
perform better in staff retention, staff stability, survey results and census.
High Achievers
These facilities achieved all 4
National Quality Goals in 2014
Alexandria Care Center, Los Angeles
Arbor Glen Care Center, Glendora
Alta Gardens Care Center, Garden Grove
Anaheim Terrace Care Center
Brookside Healthcare Center, Redlands
Cloverdale Healthcare Center
Copper Ridge Care Center, Redding
Encinitas Nursing & Rehabilitation Ctr
Glenwood Care Center, Oxnard
Golden Living Center, Sanger
Kindred Nursing & Rehabilitation Ctr
- Golden Gate, San Francisco
Panorama Gardens, Panorama City
San Mateo Medical Center DP/SNF
St. Francis Extended Care, Hayward
California nursing homes that
achieved one or two
National Quality Goals
545
Service with a Smile
Employees at the Hayward
Healthcare and Wellness Center
participated in a blood donation
drive and a clean-up effort
during a Meet and Greet the
Neighborhood event.
The American Health Care Association’s National Quality Award Program
provides a pathway for long-term care providers to journey towards
performance excellence. The program is based on the core values and
criteria of the prestigious Baldrige Performance Excellence Program.
Member centers can apply for three progressive levels of awards,
Bronze – Commitment to Quality
Silver – Achievement in Quality
Gold – Excellence in Quality
Each level has its own distinct rigors and requirements for quality and
performance excellence.
National
Quality
Awards
In 2014, six nursing facilities
received a national Silver Quality
Award including:
Edgemoor, Distinct Part SNF, Santee
Golden Living Center-Fresno
Kindred Nursing & Rehabilitation
- Golden Gate, San Francisco
Mission Skilled Nursing & Sub-Acute
Center, Santa Clara
Sonoma Valley Hospital Distinct Part
SNF, Sonoma
Vintage Faire Nursing and
Rehabilitation Center, Modesto
California facilities receiving a
Bronze Award
21
Silver Award winners from Edgemoor (left)
and Golden Living Center-Fresno travelled to
Washington, D.C., to accept their awards.
Go for the Gold!
There were cheers, congratulations and confetti in
the hallways of Stonebrook Healthcare Center after
employees learned the facility achieved a
Gold National Quality Award – the first ever
in California.
“You have to start with a happy engaged
workforce,” said Lori Cooper, Stonebrook
Healthcare Center administrator. “If you
have happy employees, they are going to
have better relationships with your customers.”
There are 15,000 nursing homes in the U.S. and
just 24 have achieved the highest level of quality
performance with a national Gold – Excellence in
Quality Award. Stonebrook, which is independently
owned, is located in Concord.
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What Our
Residents
Are Saying
The best measurement of quality is listening to what families
and nursing home residents have to say about their care.
Juanita Eisenbeis, age 99
Resident of Vienna Nursing and
Rehabilitation Center, Lodi
“Vienna met all our needs and has lived up
to our expectations. Residents are treated
with respect, dignity and love.”
- Charles and (daughter) Mudgie Brent
Jesus Montoya
“With the help of my friends,
my Edgemoor physician and
staff, I began going to school,
and this has helped me a lot.
I would never have been able
to accomplish my dream of
going to school if I were not
at Edgemoor. I received my
bachelor’s in social work and am
currently doing my internship in
a nearby nursing home.”
- Jesus Montoya, resident of
Edgemoor Hospital, Santee
Robert Luckadoo
Resident of Lincoln Glen Nursing
Facility, San Jose
“Everyone has treated Dad so
thoughtfully while he has been at
Lincoln Glen. I am truly grateful.”
- Susan Martin, daughter
Ana Lopez
Resident of The Californian,
Santa Barbara
“I love it here. Everyone is
so caring I don’t want to go
home.”
Jesus Montoya
Carmen Romero
(second from left)
Resident of Santa Teresita
Manor Skilled Nursing, Duarte
“This is a very nice place. It’s
private. I enjoy the Sisters and
the spirituality and being able
to go to daily Mass. Being able
to pray the rosary daily is a
blessing.”
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Skilled-Nursing (SNF) and Intermediate-Care Facilities
Skilled-nursing facilities (SNFs) provide nursing care on a 24-hour basis.
Intermediate-care facilities (ICFs) provide regular medical, nursing, social
and rehabilative services in addition to room and board for indivivduals not
capable of independent living.
Facility Demographics
• There are approximately 1,260 licensed nursing facilities in California
(SNF and ICF, including long-term care units of acute hospitals, also
known as distinct parts).
• California’s licensed long-term care facilities employ more than
165,000 caregivers and other staff.
Freestanding NFs
by Size
100+ beds
32%
100+ beds
60-99 beds
60-99 beds
42%
1-59 beds
Percentage of residents
needing assistance
Bathing
Dressing
Feeding
Toliet Use
Transfer
98%
96%
69%
94%
91%
Other Health
Characteristics
Resident Population
• As many as 300,000 Californians are cared for annually in licensed
long-term care facilities.
• On average, 62% of residents are female and 38 % are male.
• The average length of stay in today’s long-term care facility is less
than three months for 83% of the resident population. Fewer than
7 % of all residents remaining in the facility are there for one year or
more.
Less than 45
years
45-54 years
3%
5%
55-64 years
12%
Patient Health
Characteristics
Activities of Daily Living (ADLs)
• Nursing facility occupancy rates in California are approximately 87%.
1-59 beds
26%
Serving the Needs
of California’s
Long-Term Care
Residents
SNF/ICF
Residents
by Age
SNF/ICF
Residents
by Age
95 or more
6%
95 or more
85-94 years
29%
65-74 years
18%
85-94 years
75-84 years
65-74 years
75-84 years
26%
55-64 years
45-54 years
Less than 45 years
Native American
1%
SNF/ICF Residents by Race
Other/Unknown SNF/ICF Residents by Race
Percentage of residents requiring
special treatment
Bladder incontinence
Dementia
Chairbound
Bedfast
Ambulatory
w/assistance
Ambulatory
Physical restraints
Dialysis
Hospice
Tube feeding
Respiratory care
Suctioning
IV Therapy
55%
38%
69%
4%
35%
6%
2.2%
3%
4%
9%
13%
3.5%
2.3%
Source: CMS CASPER data, Jan. 2015
16%
Asian/Pacific
11%
Black
11%
White
Black
White
59%
Asian/Pacific
Native American
Other/Unknown
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Founded in 1950, the
California Association of
Health Facilities is a non-profit,
professional organization
representing more than 800
skilled-nursing facilities and
500 intermediate care facilities
for individuals with intellectual
disabilities. Each year, our
135,000 caregivers provide
short-term rehabilitation,
long-term care, end-of-life
assistance and habilitative
nursing services for 300,000
people. CAHF is the largest
provider of continuing
education for long-term care
providers in California. For
more information, visit www.
cahf.org
2201 K Street
Sacramento, CA
95816
(916) 441-6400
cahf.org