According to the Centers for Disease Control and Prevention, 1.5 million people ages 65 years and older lived in nursing homes in 2003. Medicare reports that 17,000 nursing homes meet the Centers for Medicare and Medicaid Service certification requirements. Medicare targeted 4,000 of the certified nursing homes for improvement because of poor performance on quality measures in a previous survey--the National Nursing Home Survey 2004--that was conducted by the CDC.
Falls
According to a CDC report titled Falls in Nursing Homes, a typical nursing home reports 100 to 200 falls yearly. Nursing home falls cause 1,800 deaths each year. In 10 percent to 20 percent of nursing home falls, serious injury occurs and 2 percent to 6 percent of these falls result in fractures. Falls occur more often in nursing homes than in older adults living in the community. Muscle weakness and walking problems account for about 24 percent of the falls. Environmental hazards contribute another 16 percent to 27 percent toward falls in nursing homes.
Pressure Sores
The CDC's National Nursing Home Survey reported 10.7 percent of nursing home residents exhibited a pressure sore at the time of the study. Pressure sores develop when sustained pressure continues on one area of the skin and cuts off circulation. The area subject to pressure produces damaged skin and tissue. Because the tissue in the affected area dies, the skin breaks open and may increase to the depth of the bone. Protracted periods in bed and in wheelchairs contribute to the problem of pressure sores.
Resident Abuse
According to the CDC's Understanding Elder Maltreatment in 2010, 551,000 individuals age 60 years and older suffered from elder abuse and neglect in domestic settings. The World Health Organization International reported deficiencies in nursing homes that lead to abuse of the elderly. Some of the factors contributing to abuse include inadequate nutrition, deficient nursing care, insufficient staff training, the inappropriate use of restraints, the likelihood of accidents in institutions and fraud involving residents' possessions.
Infections
The CDC's Prevent Antimicrobial Resistance in Healthcare Settings reports the occurrence of antibiotic-resistant infections in 27,000 nursing home residents a year. Two out of every three nursing home patients require at least one course of antibiotics annually. The infections result from wounds, problems in the urinary tract and the lungs. Pressure sores are the main source of wounds. Urinary catheters commonly produce infections, and pneumonia is a common lung infection.
Quality Improvement
The Centers for Medicare and Medicaid Services, or CMS, launched a Quality Improvement Organization Program to target deficiencies in nursing homes. Two quality measures chosen as measurements for improvement include reductions in pressure ulcers and use of restraints. CMS targeted 4,000 nursing homes in an effort to improve these two markers of quality care, setting goals of an 8 percent reduction in pressure ulcers and a 20 percent reduction in physical restraints.
References
- Medicare: Nursing Homes
- Centers for Disease Control and Prevention: The National Nursing Home Survey: 2004 Overview
- Centers for Disease Control and Prevention: Falls in Nursing Homes
- Centers for Disease Control and Prevention: Prevent Antimicrobial Resistance in Healthcare Settings
- Centers for Disease Control and Prevention: Understanding Elder Maltreatment
