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Op-ed penned by IHCA/INCAL President, Zach Cattell

Posted Mar 20, 20204 min Read

Op-ed: Indiana’s nursing facilities embrace continuous quality improvement

The Indianapolis Star published this op-ed penned by IHCA/INCAL President, Zach Cattell.


As a representative of nearly four of every five nursing facilities across Indiana, I am saddened and disappointed on many levels at IndyStar’s recently released coverage of nursing home care.

First and foremost, I am sorry for the residents and families who have experienced much pain and loss. I feel sorrow for the tens of thousands of hard-working nurses, nurse aides, therapists, housekeepers, administrators, and more who will read this story and feel yet another punch in the gut, notwithstanding their overall excellent work in caring for the most vulnerable among us. Lastly, I am also disappointed that a reputable press outlet would resort to sensationalized storytelling that perpetuates stereotypes and encumbers the very thing they support — improvement in quality care.

IndyStar also asks where the additional federal funding has gone when discussing operations by county hospitals. The funds received by nursing homes from county hospitals have been used responsibly. The No. 1 use of funds has been for increased wages for nursing facility staff, followed by increases for staff training and staff-to-patient ratios, and expanding clinical services. Additionally, operators have invested significantly in improvements to buildings and health care technology.

Our nursing facilities want to hire more staff. Unfortunately, even with the most sophisticated recruiting efforts and increases in wages, there often are not enough workers and nurses to hire across all sectors of health care. These are facts that are glossed over in the coverage.

My organization has supported and continues to support payment of the additional federal funds based on quality and other measures, which was part of a much larger plan to help increase funding for home-based services dating back to 2015. Again, facts that are not discussed. Rather focus has been turned to a handful of very unfortunate events, some dating back to 2011, and blame has been cast on a complex funding mechanism that even with its flaws is vitally important to provision of hands-on care.

Perfection should not be the measuring stick of quality, nor should suboptimal care be left unaddressed particularly when caring for our elderly — and it isn’t. Indiana’s nursing homes embrace continuous quality improvement and run daily care plan meetings and quality assurance performance improvement committees, which are all overseen and measured by the government.

Though there are measures we must improve upon, our centers have markedly reduced pain reoccurrences, indwelling catheter usage, restraints, urinary tract infections (UTIs) and antipsychotic medication use. This all has been done in the most challenging labor market across all sectors in a generation.

I applaud the leadership of Seema Verma, Centers for Medicare and Medicaid Services (CMS) administrator, and her agency’s rollout of a five-part strategy to strengthen and improve nursing home quality and the government’s oversight role. Critical to the success of our sector is having a CMS administrator who is willing to dive deeply into the issues within one of the most complex regulatory systems in the nation of any regulated sector.

Very deep in IndyStar’s coverage is something that should be promoted — what to consider when choosing nursing facility care. These are exactly the things we tell prospective residents and families as we counsel them on these difficult choices.

The choice of an individual to receive care in a nursing home is not taken lightly, and it is an immense responsibility of those who provided care to get it right the first time. What families and concerned friends should do if they feel a nursing facility is not providing good care is to report it to the Indiana State Department of Health so it can be properly investigated and corrections enforced. They should also talk with the facility leadership because they absolutely want to provide excellent care. There is no perfect system when people are taking care of people and errors do occur. However, using proper channels set up by the government is the way to seek help and change.

As we debate the various issues of nursing facility care, let us not forget the tens of thousands of health care workers who tirelessly serve our aging population every day in nursing facilities, assisted living communities, and at home. This is as critical as it has ever been now as our state’s nursing facilities and other long-term care options care for the most fragile during the COVID-19 pandemic. We should be pulling together right now and not stoking fears.