Safety Challenges in Long-Term Care

Quality and safety remain major challenges in many nursing homes. With a broad spectrum of quality across settings, some facilities are able to achieve targeted safety and quality standards while others fall behind. The articles in this issue of Annals of Long-Term Care draw attention to issues that may impede the provision of high-quality care to residents as well as pose a threat to their safety.

The importance of the nursing home administrator (NHA) position for quality is recognized by federal and state jurisdictions. Licensure serves the public interest by implementing a set of standards for knowledge and expertise in positions of high professional responsibility. But additional state-level requirements for formal education and training vary considerably across states. Studies finding positive associations between NHA education or additional professional development activities and various measures of quality processes and outcomes suggest some NHAs may be inadequately prepared to ensure high-quality services.

To better understand the education, training, and experience that supported their preparedness for the NHA role, Elena O Siegel, PhD, RN, and Leehu Zysberg, PhD, interviewed 26 NHA participants from a previous study concerning their perspectives on their education, training, and experience in preparation for their first licensed position. The results of the survey are helpful for NHAs seeking new employment and can inform directions for further studies examining NHA preparedness and licensure requirements.

Increased complexity of chronic care among older adults has led to polypharmacy and potentially inappropriate medication use, which can contribute to drug-induced diseases, adverse drug reactions, drug interactions, cognitive impairment, falls, hospitalization, and mortality. It is estimated that adverse drug reactions are approximately 7 times more common in persons greater than 70 years of age than in those younger than 70 years of age.

While exciting, new drug therapies for older adults also have potential safety challenges. Michael Koronkowski, PharmD, CGP, and colleagues discuss the recent medication safety literature regarding medications often prescribed to older adults. The associated safety concerns of the medications and implications for long-term care practitioners may be used to inform and improve care delivery for older adults across health care environments.

Among the situations that are often vexing to both health care professionals and the families of nursing home residents is that of intimacy and sexual engagement. Anyone involved in the long-term care setting is aware of the complexity and variability of the sexually related issues that arise. Sometimes a situation appears so dramatic or out of the ordinary that it becomes a high-profile media event, which often serves to highlight the many important concerns involved, beyond the specifics of the case that brought the subject to media attention. Using a high-profile case involving sexuality of a nursing home resident, Michael Gordon, MD, MSc, FRCPC, discusses the ethical implications and issues surrounding this topic in relation to care professionals and older adults with dementia.

Just as breathing is a vital function for long-term care (LTC) residents, good pulmonary management is vital to the LTC facility. Two of the five Medicare hospital readmission penalties are related to the quality of pulmonary management; when patients who are hospitalized for both pneumonia and chronic obstructive pulmonary disease (COPD) are hospitalized in less than 30 days, the initial hospital is penalized. Additionally, four of the Centers for Medicare and Medicaid Services (CMS) skilled-nursing facility (SNF) quality measures focus on pulmonary vaccinations. Finally, the focus of CMS on antibiotic stewardship requires appropriate pulmonary management, because antibiotic treatment for viral infections or development of a potentially preventable bacterial pulmonary infection is increasingly being viewed negatively for facilities. For all of these reasons and more, appropriate pulmonary management is vital for patients and SNFs alike.

In this month’s installment of “LTC GPS,” Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, and Eamon Kelleher, BA, discuss the importance of efficient and effective diagnosis and treatment for COPD, vaccination programs to prevent pulmonary infections, and antibiotic stewardship programs for ensuring high-quality pulmonary management in long-term care.

The articles in this issue demonstrate the importance of attending to issues that may pose safety challenges for residents in long-term care facilities.