How to Improve Quality Measures in Long-Term Care

Improving quality control measures at your Long-Term Care facility can be challenging
It helps to know how the Centers for Medicare and Medicaid Services (CMS) quality measures fit into the Star Rating System
Quality measures depend on what actually happens during the care delivery process
Product and equipment selection is important for quality improvement, but not a silver bullet
It is helpful to have a sustainable improvement model

Improving Centers for Medicare and Medicaid Services (CMS) quality measures is not an easy task. These quality measures are well known to industry executives, including administrators of long-term care (LTC) facilities. But knowing them and being able to enhance them in a way that results in a better operation at an LTC facility can be challenging.

Typically, LTC operations focus on compliance issues. They are constantly being brought to the attention of administrators and staff, and they almost always come with well-defined penalties for failure to adhere to them. What is not paid as much attention to as compliance is an LTC facility’s ability to implement measures that improve the quality of care. It might seem easier to theorize upgrades in quality measures, but putting them into effect can be considered ambitious to many LTC administrators.

For example, quality outcomes are typically symptoms of more substantial operational constraints. There are many factors that go into identifying and implementing improvements in quality control measures. That is why it is essential that, as an administrator, you focus on all aspects of your operation at your LTC facility before changing quality measures for your patients and staff.

What CMS Quality Measures Truly Reflect

CMS Quality Measures are standardized tools designed to evaluate and report on the safety, effectiveness, and efficiency of healthcare services, aiming to improve patient outcomes and guide value-based purchasing.

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare medical facilities, including LTC facilities and nursing homes, more easily and to help identify areas about which you may want to ask questions.

Many long-term care administrators are concerned about their facility’s Centers for Medicare and Medicaid Services (CMS) star ratings, and for good reason. CMS ratings measure the quality of care a long-term care facility provides and often play a key role in a potential resident’s facility selection process.

CMS quality measures for LTC facilities serve as one of three core domains in the Five-Star Quality Rating System. Based on data from the Minimum Data Set (MDS), these 10+ measures—covering topics like pain, pressure ulcers, and falls—are scored, ranked, and converted into a 1–5 star rating that directly impacts the overall facility score, with top performers gaining a star and low performers losing one. Scores are converted into a 1–5 star rating that influences the overall facility rating.

What Quality Measures Represent

Functional Outcomes

Quality control measures in this instance evaluate the objective, measurable assessments of a patient’s ability to perform daily activities, tracking physical, cognitive, and social progress or decline from admission to discharge. These targeted measures assess self-care, mobility, and quality of life, serving as key indicators of care quality and therapy effectiveness.

CMS measures include both clinical and functional indicators, not just ADLs.

Safety Events

When it comes to safety events, these include falls during transfers or exercises, for example, and other types of accidents. What is recorded here is the frequency of accidents that jeopardize the safety of patients at an LTC facility. For example, to what extent is a patient’s safety being compromised based on the care they are receiving?

Consistency of Care Delivery

Quality control measures in this case evaluate the care a patient is receiving and how that translates into meeting their rehabilitation goals. For instance, is the type of care being delivered leading to consistent objectives being met when it comes to regaining independence and mobility, and being able to accomplish simple, daily activities?

Common (and Necessary) Strategies that Facilities Already Know

There are various strategies available to administrators at LTC facilities to improve their quality measures. They include everything from training your employees to implementing infection control protocols.

Here is a list of the ways you can attempt to upgrade quality measures at your healthcare facility.

Care Plan Consistency

Make sure all aspects of your care plan, from the way patients are treated, their rehab regimens, and data collection, are all consistent so they can be easily measured. Consistency is vital when it comes to reliably and thoroughly evaluating your systems.

Staff Education and Training

It is imperative that you educate your staff on the best practices for occupational and physical therapy to ensure that your patients consistently receive the best quality care. As an administrator or CEO, it is your responsibility to be certain your staff receives the latest resources, tools, and equipment so they can perform their jobs at a high level. Consider ways to modify and enhance training techniques to ensure employees are able to sharpen their skills.

Documentation Accuracy and Timeliness

Nothing is more critical in your facility operation than accurately and precisely documenting the progress your patients are making. Your effectiveness is dependent on the accuracy of all record-keeping practices you implement. Also, making sure your documentation is timely is essential when it comes to ensuring your patients receive the highest quality care.

Fall Prevention Programs

Considering your facility is treating people who can be very unsteady and have a tendency toward falling, it is important to have fall prevention programs in place to help ensure the safety of your patients. Make sure that within these programs, you account for various types of therapy exercises and transfers, as well as diverse body types.

Infection Control Protocols

In order to ensure the safety of your patients and their health and wellness, make it a priority to implement comprehensive infection control protocols at your LTC facility. Be sure to enact these protocols in all areas of your operation, as an infection outbreak could have severe consequences for your healthcare facility.

Keep in mind that even if you establish these aforementioned programs and policies, it can still seem daunting and difficult to successfully improve quality measures at your LTC building.

Why Outcomes Stall Even with Good Processes

LTC facilities like yours can struggle to improve quality measures due to high resident acuity, severe staffing shortages, and inadequate training for complex care. Limited financial resources can also hinder progress on quality measures.

It is important to keep in mind that what actually occurs during care delivery does not always coincide with what is intended in your strategic operational plan. Various limitations and shortcomings can take place that can sabotage your grand design for improvement in quality control measures.

Here are four specific facets of your LTC facility operation that could pose an obstacle to enhancing quality measures.

Time

The limits of time could make it difficult to meet your goals when it comes to improving quality measures. The quickness that is involved when it comes to getting patients through their exercises or transferring them from one set of equipment to another can result in lapses in care, for example. Therapists can at times feel rushed to record health data during a patient’s rehabilitation. These are just some of the reasons that time can undermine objectives to upgrade quality control measures.

Physical Strain

When therapists or nurses work with patients of size during their rehab exercises, they could experience inordinate physical strain. This can lead to slips, falls, and other accidents that affect the quality of care at your LTC facility.

Safety Concerns

There are various ways that safety concerns can arise, including not properly operating complex equipment, not handling patients – especially bariatric patients – carefully enough. If you don’t have enough employees assisting with transferring bariatric patients from one set of equipment to another, that poses a safety risk. Adhering to strict safety protocols is a significant way to successfully improve quality measures at our LTC facility.

Staffing Availability

Cases of understaffing can compromise your ability to achieve quality measure goals. Similarly, high staff turnover, leading to challenges in training employees, poses another barrier to improving your operations.

Ultimately, achieving quality measure outcomes comes down to the point of execution.

Understanding Upstream Drivers of Quality Measures

Quality measures are influenced upstream by the following factors:

Environment

Your work environment can play a pivotal role in your healthcare facility’s ability to meet quality measure goals. For example, having a clean, unencumbered therapy gym can make a big difference when it comes to the quality of patient care during rehab.

Workflow Design

Is your facility’s operation efficient, and adaptable and flexible to allow for various contingencies? It also helps if your workflow design can allow for upgrades based on trending rehab needs of patients and new technologies in rehab equipment.

Physical Demands Placed on Staff

How stretched are your occupational and physical therapists when it comes to patient loads? For example, do you have an adequate number of therapists allocated toward specific patients based on their medical needs and physical size? Also, be sure that your staff is competently trained on the latest rehab equipment so their patients can reach their goals for independence and mobility.

How Easy (or Hard) It Is to Deliver Consistent Care

Are your therapists, nurses, and aides regularly receiving the best training available for the use of equipment, as well as data entry, and documentation of their patients’ progress? Does your staff have access to the best and most technologically advanced equipment available to ensure their patients achieve their rehab goals consistently? Answering questions like these will go a long way toward ensuring consistent care is delivered to all patients.

Additionally, mobility, transfers, and functional practice are critical drivers in rehabilitation and clinical outcomes, directly influencing numerous measures of patient independence, safety, and health. These practices include sitting-to-standing, bed mobility, and walking, and they are used to assess and improve a patient’s ability to function in daily life.

Product and Equipment Selection as a Quality Enabler (Not a Silver Bullet)

It is worth emphasizing that bringing in new equipment won’t by itself guarantee an improvement in quality measures. You need to have support systems in place and a well-trained staff in order to help ensure you move the needle on upgrading quality measures.

The right rehab products can support safer, more consistent care delivery that may contribute to improved outcomes.

However, here is what the right rehabilitation equipment can do for your LTC facility.

Decrease variability in care delivery
Make safe mobility more repeatable
Allow therapy to happen more consistently, even with staffing constraints

When it comes to top-of-the-line, best-in-market rehab equipment, consider the Barihab™ Treatment and Assessment Platforms – which not only improve patient results, but also support improved outcomes. For example, the S2S Standing Frame™ by Therapeutic Industries combines the essential support of a traditional standing frame with the added functionality of a sit-to-stand lift. The S2S allows patients to complete rehabilitation exercises directly from their rooms, eliminating the need for transport to the therapy gym.

Highly capable products like the pioneering Barihab™ therapy equipment will put you much farther toward improving quality measures than simply achieving a large quantity of sales.

From Checklists to Capability: A More Sustainable Improvement Model

There are a number of ways your LTC facility can approach the task of improving quality measures. For example, your healthcare facility can choose to move forward in one of two ways.

Reactive Improvement: This might involve audits to identify weaknesses in your operation. You could also go about improving quality measures by making spot corrections with your staff or in your delivery care system. Another option in this category is to engage in retraining of your staff to ensure they are properly utilizing equipment and are adept at handling patients.

Proactive Improvement: You might opt to design systems that make quality easier. For example, create a simpler, easy-to-track system for patient documentation or equipment purchases. Establish a database that makes updates and other changes simple to maintain and enhance. Have universal systems in place that are intuitive and user-friendly so recording and tracking patient care is simple and straightforward.

The key concept to keep in mind when it comes to developing a successful improvement model is to emphasize sustainability over short-term compliance.

What to Evaluate When Looking at Upstream Improvements

There are many and various aspects of your operation that you should consider as you seek to make upstream improvements. Think about staffing, product purchases, and the environment at your LTC facility as you make plans to improve quality measures. Most of all, be sure that patient care is consistent, implement adequate staff training, have measures in place to prevent falls, and focus on documentation accuracy.

The right rehab equipment can also make a significant difference as you set out to upgrade your quality measures.

In the meantime, here are evaluative questions to think about as you begin the improvement process and identify potential quality control measures:

Will a particular measure reduce risk during routine care?
Does it make functional practice easier to deliver consistently?
Does it decrease physical strain on your staff?
Does it support, rather than complicate, documentation and care plans?