LTC Chapter 5 and 18 Flashcards

Questions and Answers

What are major limitations of regulations in nursing homes?

They establish only minimum standards of quality, regulatory agencies cannot continuously monitor compliance, and there are wide variations in survey results.

What does the Affordable Care Act direct the CMS to implement?

A Quality Assurance and Improvement Program (QAPI) in certified facilities.

Quality can be improved without measuring it.

False

QAPI will be a ______ approach to improve quality.

data-driven Signup and view all the answers

Which of the following are quality attributes of a meal?

Diet conformance Signup and view all the answers

What is essential to evaluate when measuring customer satisfaction?

Reliability and validity of the survey instrument. Signup and view all the answers

What are nursing home report cards known as?

Nursing Home Compare Signup and view all the answers

What is required for Continuous Quality Improvement (CQI)?

Total organizational effort involving all associates. Signup and view all the answers

Commitment and support of ______ management is essential for CQI.

top Signup and view all the answers

Fear of failure fosters innovation in CQI.

False Signup and view all the answers

What does the Deming cycle (PDSA) stand for?

Plan, Do, Study, Act. Signup and view all the answers

Which principle emphasizes that quality breakdowns are attributable to management?

Value = Quality/Cost Signup and view all the answers

Which approach is driven by the interdependency of functions in CQI?

Interdisciplinary work teams Signup and view all the answers

What does a quality culture aim to achieve in an organization?

Retention and attraction of like-minded associates who prioritize quality. Signup and view all the answers

What is one of the responsibilities of top management in CQI?

Allocate resources for CQI and commit to training. Signup and view all the answers

Why does the health care sector regulate?

The government is a major payer and clients are often frail and vulnerable. Signup and view all the answers

What are the requirements of participation according to the Nursing Home Reform Act?

Regulations that govern federal certification overseen by CMS, with monitoring delegated to each state. Signup and view all the answers

What is substantial compliance?

A level of compliance such that any identified deficiencies pose no greater risk to patient health and safety than the potential for causing minimal harm. Signup and view all the answers

What are the types of surveys provided by the State Operations Manual?

Abbreviated standard survey Signup and view all the answers

What is the Quality Survey Indicator?

It is computer-based and designed to produce standardized resident-centered outcome-oriented quality review. Signup and view all the answers

What consists of a standard survey's tasks?

Initial tour Signup and view all the answers

What does offsite preparation involve?

Potential areas of concern at the targeted facility based on compliance history. Signup and view all the answers

What happens during the entrance conference?

Signs are posted to notify that a survey is in progress. Signup and view all the answers

What is the purpose of the initial tour?

To gather information about residents, staff, and facility conditions. Signup and view all the answers

How is the resident sample selected?

By stratifying the case mix to include both heavy and light care patients. Signup and view all the answers

What does information gathering include during surveys?

Patient care, medication errors, food preparation, and residents' quality of life. Signup and view all the answers

What is determined during the compliance determination?

Deficiencies are cited when standards are not met, based on severity levels. Signup and view all the answers

What does the Americans with Disabilities Act (ADA) require for nursing facilities?

Facilities must be accessible by the disabled and provide necessary adaptations. Signup and view all the answers

What is OSHA's primary mission?

Workplace safety. Signup and view all the answers

What do OSHA record-keeping requirements entail?

Keeping records of recordable injuries for five years using different forms. Signup and view all the answers

What does survey enforcement require?

Substantial compliance and continuous monitoring of health and safety standards. Signup and view all the answers

What are CMS guidelines?

They clarify survey standards, procedures, and compliance guidance. Signup and view all the answers

What is a plan of correction?

A document outlining how deficiencies will be corrected and avoided in the future. Signup and view all the answers

What happens in cases of immediate jeopardy according to enforcement and remedies?

Possible termination from Medicare/Medicaid or monetary penalties may be imposed. Signup and view all the answers

What factors contribute to the five-star quality rating of nursing homes?

Quality Measures, Staffing, and Health Inspection. Signup and view all the answers

What does the Life Safety Code apply to?

Inpatient facilities housing four or more patients incapable of self-preservation. Signup and view all the answers

What are the requirements under NFPA regarding fire resistive construction?

No fireplaces are permitted in patient rooms. Signup and view all the answers

What is the relationship between productivity and quality in healthcare?

Improving productivity is challenging due to the labor-intensive nature of patient care. Signup and view all the answers

What are the four important components of quality in healthcare?

Consistent delivery of services, maximizing well-being, producing desirable outcomes, minimizing undesirable consequences. Signup and view all the answers

What are evidence-based practices?

Standardized methods aimed at decreasing variability in care and improving outcomes. Signup and view all the answers

What do consumer-defined quality complaints refer to?

Consumers' impressions based on personal observations and experiences. Signup and view all the answers

What role do structures play in quality patient care?

Structures provide the necessary foundation for delivering high-quality patient care. Signup and view all the answers

What is the importance of processes in healthcare?

Processes are methods designed to produce desired outcomes in care delivery. Signup and view all the answers

What are outcomes in the context of healthcare quality?

Final results produced by structures and processes evaluated against care plans. Signup and view all the answers

What are regulatory minimum standards?

Compliance with certification standards used as a proxy for quality of care. Signup and view all the answers

Study Notes

Regulation of Health Care Sector

Major payer is the government, highlighting the financial stakes in health care.
Clients in health care are often frail and vulnerable, necessitating regulation for their protection.

Requirements of Participation

Governed by the Nursing Home Reform Act; federal certification requires compliance monitored by CMS and states.

Substantial Compliance

Refers to a level of compliance wherein deficiencies pose minimal risk to patient health and safety, ensuring no significant harm arises from violations.

State Operations Manual Surveys

Four survey types:
- Standard: Common, periodic, unannounced; certification renewal required within 15 months.
- Abbreviated Standard: Shorter survey; focuses on specific complaints or ownership changes.
- Extended: Detailed investigation when quality of care concerns arise.
- Post-survey Revisit: Follow-up to ensure compliance and address previous noncompliance.

Quality Survey Indicator

Computer-based system enabling comprehensive care delivery reviews.
Two-stage process:
- Stage 1 investigates all regulatory areas;
- Stage 2 conducts in-depth interviews on identified issues.

Standard Survey Components

Seven tasks including offsite preparation, entrance conference, and exit conference.

Offsite Preparation

Analyzes potential concerns based on prior compliance history and demographic data of the facility.

Entrance Conference

Notification signs posted in facilities to inform about ongoing surveys and encourage concerns from residents and staff.

Initial Tour Overview

Approximately two hours in facilities with 100 beds.
Involves discussions with residents and staff, and assessments of educational, social, and service aspects.

Resident Sample Selection

Ensures diverse patient representation, including varying care levels and cognitive abilities.

Information Gathering

Observations and interviews focus on care quality, medication accuracy, and residents' quality of life.

Determination of Compliance

Deficiencies categorized as resident-centered or facility-centered, with severity assessed based on potential health outcomes.
Severity levels range from minor to immediate jeopardy.

General Accessibility Standards

Nursing facilities must adhere to the Americans with Disabilities Act (ADA), ensuring disabled accessibility in the building, including ramps and protected entrances.

OSHA and Workplace Safety

OSHA aims to enhance workplace safety, especially considering high nonfatal injury rates among nursing assistants.
Nursing homes had an injury rate of 12.5 incidents per 100 full-time workers, significantly higher than the industry average.

OSHA Record Keeping

Various forms required for documenting injuries, maintained for five years.

Survey and Enforcement

Emphasis on substantial compliance, requiring frameworks for continuous adherence rather than zero tolerance.

CMS Guidelines

Manuals outline standards and compliance verification, aiding nursing home personnel in meeting regulations.

Plan of Correction

Must be submitted within 10 days post-deficiency identification, detailing correction strategies and sustainability.

Enforcement and Remedies

Immediate responses required for serious deficiencies include potential termination from Medicare/Medicaid.

Five-Star Quality Rating System

Ratings based on quality measures, staffing, and health inspections to gauge nursing home performance.

Life Safety Code Compliance

NFPA 101 regulates fire safety in inpatient facilities with specific construction and exit requirements.

NFPA Requirements

Fire resistive construction, space subdivision, vertical openings protection, adequate means of egress, and emergency preparedness mandates are vital.

Productivity and Quality Challenges

Balancing productivity with the quality of care is essential due to the labor-intensive nature of patient care.

Cost and Quality Relationship

High-quality services can lead to reduced overall costs through efficient staff management and care delivery.

Quality Definition

Involves consistent service delivery, maximizing well-being, generating positive outcomes, and minimizing negative consequences.

Evidence-Based Practices

Standardizing processes through established guidelines enhances care delivery quality.

Consumer-Defined Quality Complaints

Quality perceptions shaped by personal experiences, emphasizing the importance of humanistic care alongside technical accuracy.

Structures and Processes in Quality Care

Structural elements determine care capabilities, while processes must lead to desired outcomes and quality improvements.

Regulatory Minimum Standards

Compliance with certification standards impacts the perceived quality of care, despite limitations such as variability in monitoring.

Affordable Care Act Impact

Directs CMS to focus on quality assurance through data-driven programs in certified facilities.

Measuring and Evaluating Quality

Measurement involves data collection and analysis against benchmarks to drive necessary corrective actions.

Focus on Outcomes

Evaluating structures and processes is vital to determine whether quality goals are successfully met.

Measuring Customer Satisfaction

Surveys assess satisfaction, requiring reliability and validity to ensure accurate representation of care quality.

CMS Quality Initiative

Public availability of Nursing Home Compare and 5-Star Ratings influences performance, particularly in competitive markets.

Quality Improvement Initiatives

Continuous Quality Improvement (CQI) emphasizes a culture of quality, involving all staff in leadership and statistical evaluations to promote ongoing enhancements.### Leadership and Culture
Commitment from top management is critical for Continuous Quality Improvement (CQI).
Key prerequisites include low turnover among top managers and strong advocacy for CQI from leaders.
Leaders should exhibit open-mindedness and strong communication skills.
A participatory, team-oriented leadership style enhances CQI effectiveness.
Top management must comprehend CQI principles and ensure appropriate resource allocation.

Top Management Support

Essential for CQI is the allocation of adequate resources.
Setting clear goals and implementation plans facilitates CQI advancement.
Implementing training and reward systems boosts staff engagement in CQI.
Acceptance of failures as a learning opportunity is crucial for innovation.
Patience and perseverance are important traits for allowing CQI to succeed.

Deming's Process Improvement Cycle

The cycle consists of four phases: Plan, Do, Study, Act (PDSA).
Planning focuses on identifying quality issues and areas for improvement.
The Doing phase involves measuring and collecting data for process understanding.
Studying requires ongoing evaluation of changes and their impact on quality.
Acting implements changes after validating their effectiveness.

Statistical Evaluation

CQI relies on data collection and measurement to assess current quality and track improvements.
Data visualization through charts helps identify trends and benchmarks deviations.

Encompassing All Departments

CQI initiatives need to address all departmental functions due to their interdependence.
Effective interdepartmental communication and coordination are essential.
Horizontal coordination aims to fulfill the needs of both external and internal customers.

Interdisciplinary Work Teams

Teams are driven by the interdependency of organizational functions.
A quality improvement committee can provide a systematic approach to CQI.
Utilizing external consultants may help address cultural aspects and identify barriers.
Organization-wide training enhances collaborative CQI efforts.

Continuous Learning

Continuous learning is integral to CQI as new methods are identified and adopted.
Understanding how individual actions affect overall workflow is vital for improvement.
Recognizing impacts on customer satisfaction is essential for quality enhancement.

Quality Culture

The culmination of CQI efforts leads to a positive quality culture within the organization.
A reward system fosters teamwork and collaboration rather than competition.
The organization builds a reputation for excellence, attracting like-minded individuals.
Commitment to persistent quality improvement is fundamental.

Deming's CQI Principles

Quality issues are typically rooted in management practices, not worker performance.
Value creation is essential for staying competitive, defined as Value = Quality/Cost.
Heavy reliance on inspections can detract from genuine quality improvement efforts.
CQI should emphasize addressing process deficiencies rather than assigning blame to individuals.
Internal competition can hinder cooperation, while teamwork enhances quality pride.
Quality improvements cannot stem from slogans; they require systemic changes in processes.
Work quotas may incentivize shortcuts; valuing workers as assets encourages quality craftsmanship.

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Description

This quiz covers important terms and concepts from Chapters 5 and 18 of Long-Term Care. It focuses on the regulations governing the health care sector and the requirements for nursing home participation. Review the critical aspects that affect compliance, client care, and governmental roles in health regulation.