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LeadingAge Global Ageing Network

Overview of the NASEM Report on the Quality of Care in Nursing Homes in the US

February 14, 2023

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Terry Fulmer, PhD, RN, FAAN

President, The John A. Hartford Foundation

Member, WHO Global Network on Long-Term Care

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A private US philanthropy based in New York City, established by family owners of the world’s first grocery chain �in 1929 (the A&P)

DEDICATED TO IMPROVING THE CARE OF OLDER ADULTS

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Mission

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PRIORITY AREAS

Age-Friendly�Health �Systems

Family�Caregiving

Serious Illness & �End of Life

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We Can Do This Globally…Together!

  • Now is the time to focus on ensuring that all of us can thrive as we age
  • We have a collective responsibility to ensure affordable access to quality care for older adults, especially those needing nursing home care
  • An evidence-based report from a trusted source is one key step for any nation working to improve long-term care

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A New Opportunity in the US:�The National Imperative to Improve Nursing Home Quality

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April 2022

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www.nationalacademies.org/our-work/the-quality-of-care-in-nursing-homes

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NASEM Study on Quality and Safety in Nursing Homes

  • National Academies of Sciences, Engineering, and Medicine – provides independent, objective analysis and advice to the US to solve complex problems - nationalacademies.org
  • 1863 congressional charter signed by President Abraham Lincoln
  • Rigorous, evidence-based process
  • Last Nursing Home report led to last major set of regulations in the US (OBRA 87)

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NASEM Overarching Conclusions

  • The way the US finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable.
  • Immediate action to initiate fundamental change is necessary.
  • Stakeholders need to make clear a shared commitment to the care of nursing home residents.
  • Ensure that quality improvement initiatives do not exacerbate disparities.
  • High-quality research is needed to advance the quality of care.
  • The nursing home sector has suffered for many decades from both underinvestment in ensuring the quality of care and a lack of accountability for how resources are allocated.
  • All relevant federal agencies need to be granted the authority and resources from the U.S. Congress to implement the recommendations of this report.

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“There need to be incentives to push care towards what matters to older adults and nursing home residents.” � - Physician and researcher from Amherst, MA

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NASEM Goals and Recommendations

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Deliver comprehensive, person-centered, equitable care that ensures residents’ health, quality of life, and safety; promotes autonomy; and manages risks

Goal 1: Deliver comprehensive, person-centered, equitable care that ensures residents’ health, quality of life, and safety; promotes autonomy; and manages risks

Goal 2: Ensure a well-prepared, empowered, and appropriately compensated workforce

Goal 3: Increase the transparency and accountability of finances, operations, and ownership

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NASEM Goals and Recommendations

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Deliver comprehensive, person-centered, equitable care that ensures residents’ health, quality of life, and safety; promotes autonomy; and manages risks

Goal 4: Create a more rational and robust financing system

Goal 5: Design a more effective and responsive system of quality assurance

Goal 6: Expand and enhance quality measurement and continuous quality improvement

Goal 7: Adopt health information technology in all nursing homes

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Another Key Step:

Communicating about the �NASEM Report and �Nursing Home Care

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Reframing Nursing Home Care in the US �How to Communicate about the NASEM Report�

Recommendation #1

Start with a solution

  • First, name a change that is needed. �Then, describe what problem(s) it will solve
  • Adopt a “we can do this” tone �(not a crisis tone)

Recommendation #2

Focus on relationships

  • Highlight interconnectedness, rather than focusing on any single group
  • Feature residents as participants, not objects of care

Recommendation #3

Emphasize collective responsibility

  • Address audiences as citizens (not just consumers)
  • Appeal to the kind of society we want to create
  • Define health equity

Recommendation #4

Paint a picture of quality care

  • Describe how quality care looks/feels/�smells/sounds
  • Offer concrete examples of what IS working
  • Reference the NASEM report and �comprehensive plan

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Thank You!

Terry.Fulmer@johnahartford.org�WWW.JOHNAHARTFORD.ORG

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