Challenges in Monitoring Quality of Care in Residential Care for Older Adults

Information to help nursing homes monitor their quality of care has been available for some time through the Online Survey Certification and Reporting System (OSCAR) and the Minimum Data Set (MDS). The problem is that there is currently no system to help organize, store, and report on this information in a way that is beneficial to consumers.

OSCAR contains facility reported site and staff characteristics and health survey deficiencies, while the MDS includes resident specific information including functional limitations, medical problems, and emotional states. Despite this information helpful for policy oversight, quality improvement, and to consumers is limited.

Very little information outside of what goes into the Nursing Home Compare report card is stored and collected in electronic form, which means that a whole lot of information regarding quality of care, care process, and facility level outcomes are collected but kept locked away in a filing cabinet. Secondly, a majority of information concerning quality of care and care cost is located only at the facility level. The current system does not aggregate facility level data along with its associated costs into a consumable report. Currently real-time information pertaining to staffing, pricing, services, and monitoring can only be obtained by contacting the facility.

In most industries information about service and product quality are widely available. However in long-term care this information can be something of an enigma to consumers.  The data and information are there and yet they are being underutilized. The current report card system gives consumers a small snapshot in time and is huge step in the right direction; however, this data can be out of date and remains disconnected from other information consumers need to make decisions (e.g. cost). Technological innovations are needed so that real time long-term care quality of care and other facility level data can be used to enhance consumer decision-making.

Source: Flores, C. Newcomer, R. 2009. Monitoring quality of care in residential care for the elderly: The information challenge. Journal of Aging and Social Policy 21:225-242.

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