Pressure Sores, Restraints, Severe Weight Loss: Find Out How Your State's Nursing Facilities Are Doing

2008 Nursing Residents' Data Analysis
by Steve Gold

The 2008 Nursing Home Data Compendium is now available (with 2007 data), and it provides useful information for disability advocates. CMS collects this data primarily from two sources - the Minimum Data Set (MDS) (data provided quarterly for each nursing home resident from nursing homes) and from OSCAR (data collected from CMS's own surveys and certifications). Also, all of this data is available in this Compendium by state.

1.  Why are people in facilities?

      A.  ADL Impairments:

Nearly 29% of persons in nursing facilities had NO Activity of Daily Living impairment; that's more than 930,840 people institutionalized at sometime during 2007 who had no ADL impairments.  Another 8.1% (260,893) had only one ADL Impairment. (Table 3.3.(e))

The following states had the largest percentage of persons in nursing facilities who had NO ADL Impairments: IL, OK, MO, KA, LA, AR.

The following states had the largest percentage of persons in nursing facilities who had only one ADL Impairment: RI, NH, IO, ND, WI, CT and MN.

Why are any persons in nursing facilities with so few ADL Impairments?
Why are States (and CMS) permitting these people to be admitted into nursing facilities and then paying Medicaid for them to be unnecessarily institutionalized?

Why aren't advocates making the States "Close the Front Door" and not admit or pay for these persons, or at least, offer them services in the community?  Even assuming that at time of admission they had multiple ADL impairments, when they no longer have them these individuals should be offered appropriate services in the community.  This does not seem like a difficult task for your state.

      B.  Cognitive Impairments:

Nearly 31.4% of residents had NO Cognitive Impairment; that's more than
886,749 persons without any cognitive impairments.  Another 12.2%
(390,025) had only a very mild cognitive impairment.  58.2% had a mild or less cognitive impairment.  (Table 3.5(3))

The following states had the largest percentage of persons with NO Cognitive Impairments:  AZ, NJ, FL, DC, NV, and MD

Our questions:  Again, why are these persons in nursing facilities, especially since many/most persons with cognitive impairments also have ADL impairments?  When one looks at both ADL and Cognitive Impairments together, a frightening picture emerges.  Have nursing facilities become the last refuge for many persons who are primarily, homeless, developmentally disabled, mentally ill?

Why is your State (and CMS) wasting Medicaid funds dollars on those persons who could easily be treated less expensively for in the community?

2.  How are People Doing in Nursing Facilities?

Many of the following are life threatening conditions. Many are actually caused by the nursing facilities' inadequate and improper treatment.
They all demonstrate that people are at significant risk when they enter a nursing facility.

      A.  Pressure Ulcers
(only if the pressure sore was at stage 2 or greater, and does not include stage 1 pressure sores)(Table 3.7 and 3.9).  They are associated with increased mortality and often require aggressive (and expensive)  medical and surgical therapy.  Prevention requires regular turning, eliminating focal pressure, and keeping the skin dry.

i.  Nationally, half of all nursing facilities (the median) had more than 7.8% of its residents with these pressure ulcers.

ii.  The following States had the highest percentages of nursing facilities (90th percentile) with residents who had stage 2 or greater pressure ulcers:  DC, CA, MD, NJ, NV, VA, and PA.  (Table 3.7).

iii.  The following States had the highest incidence of pressure ulcers which occurred while the residents were entirely under the care of the nursing facility, i.e., they did not have these ulcers on admission: IN, KY, DC, PA, and WY. (Table 3.9)

      B.  Use of Physical Restraints
(whether trunk restraint, limb restrain or some sort of restraining chair):

i.  Nationally, half of all nursing facilities (the median) had more than
2.3 % of its resident who were put in physical restraints.

ii. The following States had the highest percentages of facilities (90th percentile)with residents in such physical restraints: LA, CA, AR, OK, MS, NV, TN, and NM. (Table 3.11).

      C.  Tube Feeding
(The following data excludes persons admitted who had feeding tubes at time of admission.) (Table 3.15):

i.  Nationally, more than half the nursing facilities (the median) had 3.2 % of their residents who had feeding tubes.

ii. The following States had the highest percentages of facilities (90th
percentile) with residents who were put on feeding tubes: HI, DC, CA, NV, MS, AK, and KY.

      D.  Weight Loss
(i.e., more than 5% weight loss in the last 30 days or more than 10% in last 180 days, and data excludes residents with end-stage disease or receiving hospice care):

i.  Nationally, half of all nursing facilities (the median) had more than 7.7% of its residents had such weight loss.

ii. The following States had the highest percentages of facilities (90th
percentile) with residents who had such weight loss: OR, NV, WY, HI, WA, VA.  (Table 3.17).

      E.  Severe Bladder or Bowel Incontinence
(Nor episodic but on almost all occasions, and therefore an indication of severe incontinence):

i. Nationally, half of all nursing facilities (the median) had more than 32.7% of its residents had severe bladder or bowel incontinence.

ii. The following States had the highest percentages of facilities (90th
percentile) with residents who had severe bladder or bowel incontinence on almost all occasions: HI, CA, SC, DC, SC, NV, VA, GA.  (Table 3.19).

3.  Nursing Facility Deficiencies

      A.  Only 8% of the states' nursing home surveys had ZERO health deficiencies' citations. (Table 4.5.(e)). The following states had the most health deficiencies cited: RI, MA, PA,.OR, NH, NV.

      B.  17.1% of all states' nursing facilities had surveys which recorded a health deficiency of "actual harm or immediate jeopardy to residents."
(Table 4.8.(e)) The following states had the most health deficiencies of "actual harm or immediate jeopardy to residents": CO, CT, DC, DE, ID, MI,, WI ,WY, NE, NM..

4.  Specific Nursing Facility Deficiencies:

      A.  Nearly 18.3% of all states' nursing facilities had surveys resulting in a citation for failure to treat or prevent pressure ulcers, but there was a wide spread among the states. (Table 4.18.(e)).

What follows is the percent of all nursing facilities by state that were cited for "Failure to Treat or Prevent Pressure Ulcers."

Alabama         17.0%
Alaska           5.3%
Arizona         17.1%
Arkansas        46.9%
California      19.8%
Colorado        20.3%
Connecticut     34.5%
Delaware        29.8%
D. C.           28.6%
Florida         10.3%
Georgia         17.6%
Hawaii          10.3%
Idaho           28.8%
Illinois        21.5%
Indiana         26.4%
Iowa            17.5%
Kansas          38.1%
Kentucky        11.5%
Louisiana       16.8%
Maine           16.2%
Maryland         9.0%
Massachus        8.5%
Michigan        19.4%
Minnesota       62.4%
Mississippi      5.9%
Missouri        26.6%
Montana         14.5%
Nebraska        21.9%
Nevada          10.9%
New Hamp         7.4%
New Jersey      14.8%
New Mexico      13.9%
New York        17.7%
North Carolina   6.6%
North Dakota     7.7%
Ohio            20.5%
Oklahoma        12.1%
Oregon          12.8%
Pennsylvania     8.8%
Rhode Island     9.3%
South Carolina  22.2%
South Dakota     4.6%
Tennessee        8.0%
Texas           10.6%
Utah             3.7%
Vermont         16.2%
Virginia        20.0%
Washington      23.7%
West Virginia    5.4%
Wisconsin       18.8%
Wyoming         15.4%

National        14.7%

Comments

[Kelly Kern]

My son was i a car accident in 2006. He has been at a nursing home for 1 1/2 years. He is 23 years old. His pressure sores are don't seem to heal. The nursing home acts as if its common. I don't agree. I don't know what to do.

[Fat loss 4 Idiots]

My grandmother suffered from extreme weight loss while in a nursing home in VA

[acai capsules]

good read and great information will bookmark thanks!

[Total Fitness Review]

Interesting read, very imformative. Bookmarked to show grandparents.

[JT @ Acai Berry Information]

Wow, I've been searching the net for some information related to a new site I'm starting in a week or so. Would you mind if I posted this article with author credit and a link back here? If not the full article just a teaser? Feel free to e-mail me and let me know. Thanks!

[pure acai berry]

Great site you have here. Enjoyed the post will bookmark. :)

[Fat Loss For Idiots Reviews]

The problem with nursing homes is that the regulations are not as strict as they should be. Or should we say the regulations are not implemented properly.

You have a useful statistics here.

[Stella]

Very informative journal! I have always wondered if we could devote enough time to our health than keeping ourselves busy working online and offline, but now I realize there is a lot of good content being posted online that is worth a read.

I belong to Alabama, and we have average health care facilities available in our hospitals. Whenever someone from our family needs to undergo a major surgery, we do not opt for our own state for the same reasons.

By the way nice info! Keep publishing!

[free weightloss information]

this is so good. thanks for the great read.

[weight loss]

thanks for your opinion keep writing