The long-term-care industry needs effective government oversight and ample staffing to boost the quality of care, according to a draft report released earlier this month by the Institute of Medicine.
The 217-page report, which the institute expects to release in final form in February, is separate from a widely anticipated report on the overall quality of the nation's healthcare that is due out early next year.
The long-term-care report updates many of the recommendations the IOM made in its landmark 1986 report on nursing homes. That study prompted Congress to pass nursing home reform legislation as part of the 1987 budget law.
In its latest report, the institute made sweeping recommendations intended to improve the long-term-care workforce, such as improving the work environment through competitive wages, career development, work design and better supervision.
"If staff are poorly educated, trained or supervised, mismatched in skills to the needs of those requiring care, demoralized by their working conditions or overwhelmed by their workload, it is virtually impossible to achieve acceptable quality care," according to the institute's report.
The report also outlines a role for federal and state governments in establishing minimum staffing levels and competency standards.
At the same time, Congress and the states should fairly compensate providers for their staffing costs by adjusting their Medicaid reimbursement formulas for nursing home care, the report said.
The institute's report also recommended that federal and state oversight efforts focus more on providers that are chronically poor performers by surveying them more frequently than other facilities.
Robert Greenwood, a spokesman for the American Association of Homes and Services for the Aging, commended the institute for its work but said its new report probably won't light a fire under Congress the way its 1986 report did.
"It points to many different areas that still need further study, so I don't think it's going to be a driver," said Greenwood, whose organization represents 5,600 not-for-profit providers.
"It definitely adds some momentum to the policy discussion that's already going on, like how we ensure that nursing homes have adequate funding, adequate staffing and provide quality care," Greenwood said. "Those are three big themes that Congress will continue to look at."
The separate institute report on the quality of healthcare in America, scheduled to be released in January or February, will be a follow-up to the institute's 1999 To Err is Human report. That study rocked the healthcare industry and the public with the estimate that as many as 98,000 Americans die as a result of medical errors in the nation's hospitals every year.
The upcoming IOM healthcare quality report will be "the rest of the iceberg," said Donald Berwick, M.D., a member of the institute's committee that authored the report.
Berwick, who also is president and chief executive officer of the Institute for Healthcare Improvement, said the new report will expand on the patient safety focus of To Err is Human to include areas such as efficiency, effectiveness and timeliness within the healthcare system.
Berwick spoke about the report at the IHI's National Forum on Quality Improvement in Health Care in San Francisco earlier this month
Berwick expressed some concern that the upcoming IOM report may not generate the same public excitement that news of 98,000 medical-error-related deaths did last year.
"That was very easy for people to understand," he said. "When you get into these other dimensions, I think it is a lot harder for people to get it."