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Nursing homes act as facilities that provide care to older patients with limited ability to perform daily activities. Geriatric patients who use the services of nursing homes often have to fully rely on the medical staff for support. Thus, the quality of care in such organizations becomes vital for preserving the patients’ health and avoiding negative outcomes. One of these preventable conditions is the occurrence of pressure ulcers – skin and tissue damage that is caused by the lack of movement out of lying or sitting positions (Resnick, 2016). This rate of pressure ulcers’ formation can be decreased if nursing homes analyze their current resources and implement new programs to promote learning and awareness about the problem. The following report will analyze four nursing homes in Essex County, NJ, and compare their data on pressure ulcers.
Nursing Homes’ Description
The discussed nursing homes are located in Essex County, NJ. The first establishment is Job Haines Home for Aged People, a non-profit situated in Bloomfield. According to the latest data, this facility has an overall score of 4 out of 5 stars, although its staff rating is significantly below average (Medicare, 2018). Job Haines Home for Aged People participates in both Medicare and Medicaid and has 40 certified beds. A non-profit corporation owns the next nursing home. Clara Maass Medical Center is located in Belleville; the center is smaller than the previous nursing home, having 20 beds and participating only in Medicare. Clara Maass Medical Center ranks above average in all scores, and it is located within a hospital (Medicare, 2018).
The following two nursing homes operate on a for-profit basis. The first one is the Hackensack Meridian Health Mountainside Medical Center, a facility connected to the hospital in Montclair. It is the smallest of all presented nursing homes, having 18 certified beds. The organization participates in Medicare but not Medicaid and has a high overall rating of 5 out of 5 (Medicare, 2018). Nonetheless, this home’s staffing score is low, indicating some problems with medical personnel. Finally, the last nursing home, Gates Manor, is the largest of the discussed facilities. It is a separate facility in Montclair with 64 certified beds and a for-profit-based partnership. This organization works with both Medicare and Medicaid and has the lowest scores out of the four homes.
Nursing Homes’ Comparison
The Medicare reports on these nursing homes show the average percentage of new and worsening pressure ulcers in short-stay residents. One can evaluate the facilities’ scores by comparing them to the national (0.9%) and state (0.6%) average results (Medicare, 2018). The first organization, Job Haines Home for Aged People, ranks lower than the average scores with only 0.3% of people developing pressure ulcers. Clara Maass Medical Center shows even lower results with 0.2% of affected residents. However, according to the gathered data, Meridian Health Center has the best result of zero patients acquiring pressure ulcers during a short-term stay. On the other hand, Gates Manor shows the worst score of 1.6% of patients developing pressure ulcers in less than 100 days after being administered to the nursing home (Medicare, 2018). This figure is much higher than the average, which suggests that the facility needs to review the factors that may exacerbate the problem.
Factors Contributing to the Incidence of Pressure Ulcers
Some aspects of patients’ stay at the nursing home directly affect their possibility of developing an ulcer. For example, older people’s limited mobility can contribute to the severity of the problem, because ulcers occur from sitting and lying in the same position for a long time (Holroyd-Leduc & Reddy, 2012). Therefore, if patients with impaired mobility are not supported or encouraged to move by the staff, their condition may worsen. The second related issue is based on poor nutrition – the maintenance of healthy skin depends on hydration and a balanced diet with enough vitamins and other nutrients, and failure to make correct dietary choices can lead to tissue breakdown and damage (Resnick, 2016). As it can be seen, geriatric patients in nursing homes require regular assistance and attention, which means that the facility has to be adequately staffed. The final problem that may exacerbate the occurrence of pressure ulcers lies in inadequate staffing.
Suggestions for Prevention and Awareness
Nursing homes should maintain a focus on preventive initiatives to increase the quality of patient care. Their strategy should include ways to improve the factors mentioned above – patient mobility, nutrition, and staffing. To promote awareness about the problem, the CMS (2013) proposes a pathway that helps evaluate the risks of patients and the preparedness of the nursing home to prevent ulcers. It includes questions that consider patient-staff interactions, medical personnel’s systemic concerns, facility policies, and care planning for each patient. The On-Time prevention initiative shows how an implementation of a computerized system of records can assist in preventing pressure ulcers (AHRQ, 2017). Olsho et al. (2014) find that by educating staff to evaluate patient risks and using regular reports to change their practice, nursing home workers can lower the rate of pressure ulcers substantially. The staff should encourage movement for patients and maintain their nutrition while gathering data to see and assess changes.
Conclusion
Pressure ulcers in nursing homes are a common problem that can be prevented. Such facilities should have enough staff members to address the issues of patients with limited mobility and poor nutrition. The staff’s education should also contain the integration of a computerized monitoring system. The visualization of patient risks and concerns in a report form will raise awareness among medical workers and motivate them to improve their practice setting.
References
Agency for Healthcare Research and Quality [AHRQ]. (2017). AHRQ’s safety program for nursing homes: On-Time prevention. Web.
Centers for Medicare & Medicaid Services [CMS]. (2013). Pressure ulcer CE pathway. Web.
Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.
Medicare. (2018). Nursing Home Compare. Web.
Olsho, L. E., Spector, W. D., Williams, C. S., Rhodes, W., Fink, R. V., Limcangco, R., & Hurd, D. (2014). Evaluation of AHRQ’s on-time pressure ulcer prevention program: A facilitator-assisted clinical decision support intervention for nursing homes. Medical Care, 52(3), 258-266.
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.
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