Raising Expectations

Nursing home residents with low care needs
The Scorecard finds a tremendous range in the percentage of nursing home residents with low care needs. Because the national trend is that people with low care needs receive services in the community, states with a relatively high proportion of nursing home residents with low care needs may be offering an inadequate array of alternatives to nursing homes. In the five top-performing states, only 5 percent of long-stay nursing home residents had low care needs. By contrast, in the bottom five states, the proportion of nursing home residents with low care needs averaged 22 percent; more than four times the rate in the highest performing states.

Policy action: Taking advantage of federal grants such as Money Follows the Person can help states to move nursing home residents who want to return to the community into their own homes or apartments.

Pressure sores among nursing home residents
A key indicator of LTSS quality is the percentage of high-risk nursing home residents who develop pressure sores, a condition that is preventable with good-quality care. The Scorecard finds that the bottom five states have more than twice the level of long-stay nursing home residents with pressure sores, compared with the top five states: 16 percent compared with 7 percent.

Policy action: States have the responsibility to establish and enforce high standards for providers and effectively monitor the quality of care nursing homes provide. Every state is funded to operate a nursing home ombudsman program, but each state can determine how frequently the ombudsmen visit each facility, how they respond to complaints, and the methods they use to monitor quality. State nursing home inspectors have a major role in enforcing federal directives to reduce pressure sores, and states can use quality bonuses to reward providers who demonstrate significant progress.