QUALITY UPDATE. California Skilled-Nursing & Rehabilitation Facilities

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1 2015 QUALITY UPDATE California Skilled-Nursing & Rehabilitation Facilities

2 Executive Overview In 2010, more people were 65 years or older than in any other previous census. Most of them will need an average of three years of long-term care services.* WOMEN MEN 3.7 years 2.2 years A recent report by the U.S. Department of Health and Human Services contained a revealing statistic people who are turning 65 years of age will need an average of three years of long-term care services at some point in their lives. While some 65-year-olds may never need long-term care, 20 percent will need it longer than five years. With 1,100 people turning 65 each day in California, that s a compelling reminder of the importance of long-term care and the ability to deliver services to residents where they need it whether in the hospital, the community, at home or in skilled-nursing centers. Members of the California Association of Health Facilities provide costeffective, high-value, 24-hour skilled-nursing care to 300,000 residents each year as a result, 80 percent are discharged within three months. As we help people return back home, we do so with a single purpose: to deliver dependable, quality care with an emphasis on attaining the highest practical level of functioning for the individual. This report outlines some of our performance achievements. California providers continue to lead the nation in five quality measure 20% will need long-term categories: Reducing depression care for more than 5 years. Reducing urinary tract infections Preventing a decline in activities Preventing falls with injury (second in nation) Preventing weight loss (second in nation) These accomplishments, and others outlined in this report, reflect the commitment of 135,000 long-term caregivers to coordinate care, reduce unnecessary hospital readmissions and transition residents to the most appropriate setting based on their needs. As we measure our progress compared to other states, we remain mindful of our responsibility to address the unique needs and challenges of each of our residents so they can experience satisfaction, wellness and quality of life. James H. Gomez CEO/President CALIFORNIA ASSOCIATION OF HEALTH FACILITIES 2 * U.S. Department of Health and Human Services

3 Unprecedented Transparency No other health care entity is more regulated than skilled-nursing facilities. Licensed by the California Department of Public Health (CDPH) and certified to provide services to eligible Medicare and Medicaid beneficiaries, skilled-nursing centers are required to maintain compliance with federal regulations. The CDPH enforces both state and federal regulations through unannounced annual surveys and complaint investigations. Consumers seeking to learn about a particular skilled-nursing facility have access to an enormous amount of web-based information on Nursing Home Compare. The federal Centers for Medicare & Medicaid Services (CMS) tracks: Five-Star ratings Inspections and complaints over the last three years Staffing hours of care per resident Quality measures Penalties During a standard survey, a team of surveyors assesses a facility s performance on more than 500 areas of care. National Leaders in Delivering Quality Nursing home quality is determined by a performance evaluation of 18 separate quality measures including the presence of pain, pressure ulcers and whether residents have received pneumonia and influenza vaccinations. California facilities lead the nation in a number of categories. CALIFORNIA QUALITY MEASURE RANKING Preventing a decline in activities #1 Preventing depression #1 Preventing urinary tract infections #1 Preventing weight loss #2 Preventing falls with injury #2 Use of antipsychotic medications in short stay residents #3 Controlling pain in long-stay residents #4 Measuring Up One component of the Nursing Home Compare website is the Five- Star Quality Rating system. The rating, which is issued quarterly, is based on a combination of factors including nursing home: Health inspections Staffing Quality measures Almost two-thirds of all skillednursing home in California 63 percent have 4 or 5 star ratings Star Rating Enriching Lives Percent of Facilities 40% 23% 15% 19% 3% Hundreds of families turned out for the annual Warm Coat Giveaway in Richmond in December. The family-owned Shields Nursing Centers have donated new coats to youths every year since

4 National Quality Initiative In 2012, the federal government turned the spotlight on the practice of prescribing antipsychotic medication to nursing home residents suffering from dementia. With a goal of improving the quality of care provided to these individuals, the Centers for Medicare & Medicaid Services initiated the National Partnership to Improve Dementia Care in Nursing Homes. The national goal called for providers to safely reduce the unnecessary use of antipsychotic medication by 15 percent by December In California, the goal was reached. Skilled-nursing providers in the state have worked hard to reduce the use of these drugs even further, and today only 1 in 6 nursing home residents are prescribed antipsychotics by their physician. California providers have performed better than most of the nation in reducing the unnecessary use of antipsychotics. Decrease in Use of Antipsychotics United States 4 California 19.4% 28% Established by our national affiliate, the American Health Care Association, the National Quality Initiative builds on existing work in the long-term care field by setting specific, measurable targets to further improve quality of care in America s skilled-nursing centers. Safely Reduce the Off-Label Use of Antipsychotics: By December 2013, reduce the off-label use of antipsychotic drugs by 15 percent. California achieved this goal in Why this is important: Using antipsychotics to treat behavior associated with dementia is not supported clinically and use of the drugs increases the risk of death. Safely Reduce Hospital Readmissions: By March 2015, reduce the number of hospital readmissions within 30 days during a skilled-nursing stay by 15 percent. Why this is important: Hospitalization is disruptive to elderly individuals and places them at greater risk for complications and infections. Increase Staff Stability: By March 2015, reduce turnover among nursing staff (RN, LVN, CNA) by 15 percent. Why this is important: Research shows that happy and satisfied staffs provide better quality care and contribute to greater quality of life for nursing home residents. Increase Customer Satisfaction: By March 2015, increase the number of customers who would recommend the facility to others up to 90 percent. Why this is important: Facilities with the highest rates of satisfaction perform better in staff retention, staff stability, survey results and census. High Achievers These facilities achieved all 4 National Quality Goals in 2014 Alexandria Care Center, Los Angeles Arbor Glen Care Center, Glendora Alta Gardens Care Center, Garden Grove Anaheim Terrace Care Center Brookside Healthcare Center, Redlands Cloverdale Healthcare Center Copper Ridge Care Center, Redding Encinitas Nursing & Rehabilitation Ctr Glenwood Care Center, Oxnard Golden Living Center, Sanger Kindred Nursing & Rehabilitation Ctr - Golden Gate, San Francisco Panorama Gardens, Panorama City San Mateo Medical Center DP/SNF St. Francis Extended Care, Hayward California nursing homes that achieved one or two National Quality Goals 545 Service with a Smile Employees at the Hayward Healthcare and Wellness Center participated in a blood donation drive and a clean-up effort during a Meet and Greet the Neighborhood event.

5 The American Health Care Association s National Quality Award Program provides a pathway for long-term care providers to journey towards performance excellence. The program is based on the core values and criteria of the prestigious Baldrige Performance Excellence Program. Member centers can apply for three progressive levels of awards, Bronze Commitment to Quality Silver Achievement in Quality Gold Excellence in Quality Each level has its own distinct rigors and requirements for quality and performance excellence. National Quality Awards In 2014, six nursing facilities received a national Silver Quality Award including: Edgemoor, Distinct Part SNF, Santee Golden Living Center-Fresno Kindred Nursing & Rehabilitation - Golden Gate, San Francisco Mission Skilled Nursing & Sub-Acute Center, Santa Clara Sonoma Valley Hospital Distinct Part SNF, Sonoma Vintage Faire Nursing and Rehabilitation Center, Modesto California facilities receiving a Bronze Award 21 Silver Award winners from Edgemoor (left) and Golden Living Center-Fresno travelled to Washington, D.C., to accept their awards. Go for the Gold! There were cheers, congratulations and confetti in the hallways of Stonebrook Healthcare Center after employees learned the facility achieved a Gold National Quality Award the first ever in California. You have to start with a happy engaged workforce, said Lori Cooper, Stonebrook Healthcare Center administrator. If you have happy employees, they are going to have better relationships with your customers. There are 15,000 nursing homes in the U.S. and just 24 have achieved the highest level of quality performance with a national Gold Excellence in Quality Award. Stonebrook, which is independently owned, is located in Concord. 5

6 What Our Residents Are Saying The best measurement of quality is listening to what families and nursing home residents have to say about their care. Juanita Eisenbeis, age 99 Resident of Vienna Nursing and Rehabilitation Center, Lodi Vienna met all our needs and has lived up to our expectations. Residents are treated with respect, dignity and love. - Charles and (daughter) Mudgie Brent Jesus Montoya With the help of my friends, my Edgemoor physician and staff, I began going to school, and this has helped me a lot. I would never have been able to accomplish my dream of going to school if I were not at Edgemoor. I received my bachelor s in social work and am currently doing my internship in a nearby nursing home. - Jesus Montoya, resident of Edgemoor Hospital, Santee Ana Lopez Resident of The Californian, Santa Barbara I love it here. Everyone is so caring I don t want to go home. Robert Luckadoo Resident of Lincoln Glen Nursing Facility, San Jose Everyone has treated Dad so thoughtfully while he has been at Lincoln Glen. I am truly grateful. - Susan Martin, daughter Jesus Montoya Carmen Romero (second from left) Resident of Santa Teresita Manor Skilled Nursing, Duarte 6 This is a very nice place. It s private. I enjoy the Sisters and the spirituality and being able to go to daily Mass. Being able to pray the rosary daily is a blessing.

7 Skilled-Nursing (SNF) and Intermediate-Care Facilities Skilled-nursing facilities (SNFs) provide nursing care on a 24-hour basis. Intermediate-care facilities (ICFs) provide regular medical, nursing, social and rehabilative services in addition to room and board for indivivduals not capable of independent living. Facility Demographics There are approximately 1,260 licensed nursing facilities in California (SNF and ICF, including long-term care units of acute hospitals, also known as distinct parts). California s licensed long-term care facilities employ more than 165,000 caregivers and other staff. Nursing facility occupancy rates in California are approximately 87%. Freestanding NFs by Size Resident Population 1-59 beds 26% beds 42% 100+ beds 32% As many as 300,000 Californians are cared for annually in licensed long-term care facilities. On average, 62% of residents are female and 38 % are male. SNF/ICF Residents by Race SNF/ICF Residents by Race SNF/ICF SNF/ICF Residents Residents by Age by Age 100+ beds beds 1-59 beds The average length of stay in today s long-term care facility is less than three months for 83% of the resident population. Fewer than 7 % of all residents remaining in the facility are there for one year or more. Native American 1% Asian/Pacific 11% Other/Unknown 16% Black 11% years 5% years 12% years 18% Less than 45 years 3% years 26% White 59% 95 or more 6% 95 or more years years 29% years White Black Asian/Pacific Native American Other/Unknown years years years Less than 45 years Serving the Needs of California s Long-Term Care Residents Patient Health Characteristics Activities of Daily Living (ADLs) Percentage of residents needing assistance Bathing 98% Dressing 96% Feeding 69% Toliet Use 94% Transfer 91% Other Health Characteristics Percentage of residents requiring special treatment Bladder incontinence 55% Dementia 38% Chairbound 69% Bedfast 4% Ambulatory w/assistance 35% Ambulatory 6% Physical restraints 2.2% Dialysis 3% Hospice 4% Tube feeding 9% Respiratory care 13% Suctioning 3.5% IV Therapy 2.3% Source: CMS CASPER data, Jan

8 Founded in 1950, the California Association of Health Facilities is a non-profit, professional organization representing more than 800 skilled-nursing facilities and 500 intermediate care facilities for individuals with intellectual disabilities. Each year, our 135,000 caregivers provide short-term rehabilitation, long-term care, end-of-life assistance and habilitative nursing services for 300,000 people. CAHF is the largest provider of continuing education for long-term care providers in California. For more information, visit www. cahf.org 2201 K Street Sacramento, CA (916) cahf.org