1. Nursing Facility Rates & Policy Division 1 LTC Issues Committee: Nursing Home Report Card Update July 24, 2007 Teresa Lewis

2. Nursing Facility Rates & Policy Division 2 Minnesota Nursing Home Report Card WHY: –Transparency to consumers –Provider benchmarking and quality improvement HOW: –Nursing homes selected by geographical areas –Facility assigned 1-5 stars on each of seven dimensions http://www.health.state.mn.us/nhreportcard/

3. Nursing Facility Rates & Policy Division 3 Minnesota Nursing Home Report Card Quality Measures - update frequency Resident quality of life ratings - annually Minnesota quality indicators - quarterly Hours of direct care - annually Staff retention - annually Temporary staffing agency use - annually Proportion of single rooms - quarterly State inspection results – quarterly

4. Nursing Facility Rates & Policy Division 4 User Priority of Quality Measures

5. Nursing Facility Rates & Policy Division 5 Report Card Usage Major Report Card Updates

6. Nursing Facility Rates & Policy Division 6

7. 7 Minnesota Nursing Home Report Card Enhancements being considered Format Drill down Refine scoring of MDH measure Add measures for family satisfaction, environment Add non-MA facilities Enable special focus on areas such as short stay, dementia DHS is interested in developing report cards for other provider types

8. Nursing Facility Rates & Policy Division 8 Quality of Life Trends 2007 data pending due to risk adjustment Overall risk-adjusted resident satisfaction for 2006: 82% High points in 2006 –Staff treating residents with dignity –Staff adapting environment to residents (significant ) Areas to target –Resident reports of negative emotions –Staff offering meaningful activities –Most quality areas had small but significant declines 05 to 06

9. Nursing Facility Rates & Policy Division 9 Quality of Life Trends Significant Changes Using Paired T-Tests are Bolded MN Average Risk-Adjusted Scores Quality of Life Area20052006Difference Dignity 96.5%96.2%-0.3% Environmental Adaptations 87.9%88.2%0.4% Security 87.9%86.7%-1.2% Privacy 87.4%86.4%-1.0% Food Enjoyment 86.3%84.8%-1.5% Individuality 84.7%84.2%-0.5% Relationships 83.3%81.9%-1.4% Comfort 81.8%81.9%0.1% Autonomy 83.6%81.8%-1.9% Satisfaction 83.7%81.8%-2.0% Overall Score 82.2%81.7%-0.5% Mood 69.7%69.4%-0.2% Meaningful Activity 68.2%68.5%0.3%

10. Nursing Facility Rates & Policy Division 10 Quality of Life Trends Significant Improvement Significant Decline

11. Nursing Facility Rates & Policy Division 11 Quality of Life Update Interviews done Feb – May 2007 Over 14,000 valid surveys NFs more satisfied with overall process –2005: 89% –2006: 94% –2007: 95% Anticipated result timelines: –Observed results were to NFs mailed in early July –Risk-adjusted results on Report Card in July

12. Nursing Facility Rates & Policy Division 12 Clinical Quality Indicators Trends 24 risk-adjusted care processes and outcomes Total change from 7/2004 to 12/2006 –20 QIs improved –Best: Pain, physical restraints, weight loss –Areas to target: Falls, burns/skin tears/cuts, mobility

13. Nursing Facility Rates & Policy Division 13 Clinical Quality Indicators Trends Significant Improvement

14. Nursing Facility Rates & Policy Division 14 Clinical Quality Indicators Update Psychoactive drug QIs now updated to reflect new clinical guidance 2006 Q1-4 QI report mailed to NFs in late June –Observed and risk-adjusted rates –Facility ranks compared to rest of state –Points received

15. Nursing Facility Rates & Policy Division 15 Risk Adjustment QoL/RS scores adjusted for resident age, gender, cognitive/physical status & LOS; facility location and average resident LOS QIs adjusted for resident age, gender, diagnoses, functional status, and health conditions Empirical Bayes estimates from multilevel models

16. Nursing Facility Rates & Policy Division 16 Direct Care Staffing Trends Hospital and standard NFs significantly increased staffing 04 to 05 Data needed for this measure was not collected in prior years

17. Nursing Facility Rates & Policy Division 17 Staff Retention Trends Retention has not changed significantly 03 to 05 All Direct Care Staff RNs, LPNs, TMAs, CNAs

18. Nursing Facility Rates & Policy Division 18 Temporary Staffing Trends NFs using no supplemental nursing staff: -- 236 (59%) in 2003-- 252 (64%) in 2004-- 268 (68%) in 2005

19. Nursing Facility Rates & Policy Division 19 Single-Bed Room Trends and Update

20. Nursing Facility Rates & Policy Division 20 Old MDH Inspection Trends Scores have declined slightly over past year

21. Nursing Facility Rates & Policy Division 21 MDH State Inspection Update Stars Awarded543221 Criterion 1 Most Recent Survey Met Met with Single-G Exception Not-Met Criterion 2 Complaints Met Not-MetMetNot-Met Criterion 3 Prior Survey MetN/A Criterion 4 Special Focus Facility Met N/A Criterion 5 Total Deficiencies MetN/A

22. Nursing Facility Rates & Policy Division 22 MDH State Inspection Update

23. Nursing Facility Rates & Policy Division 23 MDH State Inspection Update NF Stars Using Old QM (Mar 07 data) NF Stars Using New QM ( Apr 07 data) ***************Total *****2225630311340 **722611147 *000303 Total2295856452390

24. Nursing Facility Rates & Policy Division 24 Questions? Teresa Lewis Nursing Facility Rates and Policy Division MN Department of Human Services PO Box 64973 St. Paul MN 55164-0973 Located at 540 Cedar St. in downtown St. Paul Voice 651-431-4208 teresa.lewis@state.mn.us