Why Quality Measures are Important to You (Long Stay Resident)

Each year, one in every three adults age 65 and older falls. One third of falls among nursing home residents results in an injury.

Falls can cause moderate to severe injuires such as:

• Bone fractures
• Joint dislocations
• Closed head injuries
• Subdural hematoma
• Altered consciousness

There are many things a facility can do to prevent falls and fall-related injuries.

Most urinary tract infections can be prevented by keeping the area clean, emptying the bladder regularly, and drinking enough fluid. Nursing home staff should make sure the resident has good hygiene. Finding the cause and getting early treatment of a UTI can prevent the infection from spreading and becoming more serious or causing complications like delirium. It is important to find out whether the UTI is caused by a physical problem, like an enlarged prostate, so proper medical treatment can be given.

Residents should be checked regularly by nursing home staff to see if they are having pain. Residents (or someone on their behalf) should let staff know if they are in pain so efforts can be made to find the cause and make the resident more comfortable. If pain is not treated, a resident may not be able to perform daily routines, may become depressed, or have an overall poor quality of life. This percentage may include some residents who are getting or have been prescribed treatment for their pain, but who refuse pain medicines or choose to take less. Some residents may choose to accept a certain level of pain so they can stay more alert.

Pressure ulcers may:

• Be painful
• Take a long time to heal
• Cause other complications such as skin and bone infections.

Pressure ulcers may worsen without proper interventions and may place residents at risk for further complications or skin injury.

There are several things that nursing homes can do that may help to prevent or treat pressure ulcers, such as frequently changing the resident's position, proper nutrition, and using soft padding to reduce pressure on the skin. Some residents may get pressure ulcers even when the nursing home provides good preventive care.

Loss of bowel or bladder control is not a normal sign of aging and can often be successfully treated. Loss of bowel and bladder control can be caused by:

• Physical problems (like constipation, muscle weakness, or a bladder infection)
• Location problems (like the bathroom is too far away)
• Reaction to medication
• Limited ability to walk or move around
• Diet and fluid intake
• Toilet routine (timing trips to the bathroom)
• Whether someone can provide assistance when needed
• Certain medical conditions such as diabetes, dementia, spinal cord injury, or neurological disease may put a resident at higher risk of losing bowel and bladder control.

Finding the cause and treating a problem with bowel or bladder control is important for many reasons. Physically, it can help prevent infections and pressure ulcers. Mentally, treatment can help the well being of the resident by restoring dignity and social interaction.

A catheter should only be used when it is medically necessary. It is used by residents who lose control of their bladder or need help to get to the toilet, or they may have to go frequently. A catheter should not be used for the convenience of the nursing home staff. Using a catheter may result in complications, like urinary tract or blood infections, physical injury, skin problems, bladder stones, or blood in the urine. Some studies have shown that long-term use of indwelling catheters (over many years) may increase the rates of bladder cancer in patients with spinal cord injuries.

Restraints should only be used when they are necessary as part of the treatment of a resident's medical condition. Only a doctor can order a restraint. Restraints should never be used to punish a resident or to make things easier for the staff. Facilities are not allowed to use restraints based solely on a family's request, unless there is a documented medical need and a doctor's order. A resident who is restrained daily can become weak, lose his or her ability to go to the bathroom by themselves, and develop pressure sores or other medical.

It is important that nursing home staff encourage residents to do as much as they can for themselves. The resident’s ability to perform daily functions is important in maintaining health status and quality of life. Some residents will lose function in their basic daily activities even though the nursing home provides good care.

A loss of 5% or more of body weight in one month is usually considered unhealthy (for example, a 140 pound person should not lose more than 7 pounds in one month). Too much weight loss can make a person weak, change how medicine works in the body, or put the resident at risk for pressure ulcers.

Too much weight loss may mean that the resident is ill, refuses to eat, is depressed, or has a medical problem that makes eating difficult (like weakness caused by a stroke). It could also mean that the resident is not being fed properly, their medical care is not being properly managed, or that the nursing home's nutrition program is poor.

To help prevent unhealthy weight loss, it is important that the resident's diet is balanced and nutritious, and that staff spend enough time feeding people who can't feed themselves. Sometimes it may be necessary for a person to lose weight for medical reasons. In these cases, the medical staff may plan in advance for the resident to lose weight on a special weight loss program, but the person should not lose more than 5% of body weight in one month.

Depression is a medical problem of the brain that can affect how you think, feel, and behave. Signs of depression may include fatigue, a loss of interest in normal activities, poor appetite, and problems with concentration and sleeping.

Feeling depressed can lessen your quality of life and lead to other health problems. Nursing home residents are at a high risk for developing depression and anxiety for many reasons, such as loss of a spouse, family members or friends, chronic pain and illness, difficulty adjusting to the nursing home, and frustration with memory loss. Identifying depression can be difficult in residents because the signs may be confused with the normal aging process, a side effect of medication, or the result of a medical condition. Proper treatment may include medication, therapy, or an increase in social support.

The "flu" (also called influenza) is a very contagious respiratory infection. Flu is spread very easily from person to person. People are usually infected when a person coughs or sneezes.

The flu shot (influenza vaccination) can prevent you from getting the flu or reduce your risk of becoming seriously ill from the flu. People who are age 65 and older are at higher risk for developing serious life-threatening medical complications from the flu. If you are age 65 or older, you should get the flu shot once every year.

Residents should be given a flu shot during the flu season (October through March). You should not get another flu shot if you have already received a flu shot at another place, or if there is a medical reason why you should not receive it. Learn more about flu shots and the elderly.

The pneumococcal shot (pneumococcal vaccination) may help you prevent or lower the risk of becoming seriously ill from pneumonia caused by bacteria. It may also help you prevent future infections.

Residents should be asked if they have been vaccinated for pneumonia, and if not, you should be given the pneumococcal shot unless there is a medical reason why you should not receive it.

Antipsychotic drugs are an important treatment for patients with certain mental health conditions. However, the FDA has warned that antipsychotic medications are associated with an increased risk of death when used in elderly patients with dementia and the medications have side effects. Therefore, these medications must be used appropriately. Interventions that do not involve medications should be used first if possible and the continued use of antipsychotics should be carefully monitored.

Consumers should ask nursing homes about their approach to managing behavior. Interventions that do not require medications, such as higher staffing ratios, many and varied activities, and consistent assignment, have been shown to be successful in many cases.