Promoting Quality and Safety with Innovative Models of Care

Promoting Quality and Safety with Innovative Models of Care 150 150 Affordable Capstone Projects Written from Scratch



Healthy People 2020


Beginning in 1980, the U.S. Department of Health and Human Services (USDHHS) has released national objectives every ten years to improve the health of all Americans. The current initiative, Healthy People 2020, has a new category for older adults, listing objectives pertaining to preventing health problems and providing of long-term services and supports for older adults—both those living at home and those living in health care institutions.


Prevention Objectives


Long Term Services and Support Objectives


Objectives under the prevention category include, but are not limited to, the following:

  • Increasing the proportion of older adults who are up to date on a core set of clinical preventative services
  • Increasing the proportion of older adults with one or more chronic health conditions who report confidence in managing their conditions
  • Reducing the proportion of older adults who have moderate to severe functional limitations
  • Increasing the proportion of the health care workforce with geriatric certification


Some of the Long-Term Services and Supports Objectives include the following:

  • Reducing the proportion of non-institutionalized older adults with disabilities who have an unmet need for long-term services and supports
  • Reducing the rate of pressure ulcer-related hospitalizations among older adults
  • Reducing the rate of emergency department visits due to falls among older adults


Increasing the number of states (including the District of Columbia) and Native American tribes that collect and make publicly available information on victims, perpetrators, and cases of elder abuse, neglect, and exploitation (USDHHS, 2013)



Data Collection and Assessment for Long-Term Care Facilities (MDS)


Long-term care facilities must balance the rising cost of providing quality care for residents who are on Medicaid with the steady decline in Medicaid reimbursement. Hicks, Rantz, Petroski, and Mukamel (2004) investigated the relationship of nursing home costs and the decline in levels of activity, development of decubiti, weight loss, and use of psychotropic drugs. Their research indicated that these negative outcomes can substantially impact the cost of care. Data on these and other adverse outcomes, as well as positive outcomes, is captured in regular assessments using the Minimum Data Set (MDS) instrument.


MDS (Minimum Data Set)


In 1987, the Omnibus Reconciliation Act (OBRA) mandated that a data-collection-and-assessment tool called MDS be used in all Medicaid- and Medicare-funded long-term care facilities. This tool was designed to assess and identify the strengths, preferences, and functional abilities of nursing home residents in a systematic way to better address their needs.

MDS 3.0 Revision


The MDS 3.0 revision, released in October 2013, addresses the lessons learned from using and testing earlier versions of the tool. It focuses on using clinical assessment to screen long-term care residents for common, often unrecognized or unevaluated, conditions and syndromes. The data is sent to the Research Data Assistance Center (ResDac), where it is compiled and studied with the aim of improving quality of life through safe and efficient use of the health care system


Medicare’s Use of MDS


Medicare uses the data from ResDac to compare the quality of long-term care facilities and nursing homes. A website with this information gives professional and nonprofessional caregivers and family members access to accurate, timely information that will help them choose a nursing home. Areas of comparison include health inspection outcomes, quality measures, staffing, number of certified beds, and safety measures, among other things. Up to three facilities in a geographical area can be compared at one time.


ANA Standards for Gerontological Nursing


How do the recommendations proposed by IOM relate to the scope and standards for gerontologic nursing? The scope of nursing practice is defined by state regulation and is also influenced by the unique needs of the population being served. The American Nurse’s Association (ANA) published Scope and Standards of Care of Gerontological Nursing Practice which includes recommendations established by nurses who specialize in the care of older adults.


Based on these standards, the American Association of Colleges of Nursing and the John A. Hartford Foundation Institute for Geriatric Nursing (2000) formulated a list of 30 recommended baccalaureate competencies and curricular guidelines for geriatric nursing care. Although they address geriatric care, these competencies apply to every student studying nursing because every area of nursing includes some contact with older adults and their families. Select the link to read each competency, and notice the ones that can also be applied to other areas of nursing.


Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care (Competencies necessary for nurses to provide high-quality care to older adults and their families:

1. Recognize one’s own and others’ attitudes, values, and expectations about aging and their impact on care of older adults and their families.

2. Adopt the concept of individualized care as the standard of practice with older adults.

3. Communicate effectively, respectfully, and compassionately with older adults and their families.

4. Recognize that sensation and perception in older adults are mediated by functional, physical, cognitive, psychological, and social changes common in old age.

5. Incorporate into daily practice valid and reliable tools to assess the functional, physical, cognitive, psychological, social, and spiritual status of older adults.

6. Assess older adults’ living environment with special awareness of the functional, physical, cognitive, psychological, and social changes common in old age.

7. Analyze the effectiveness of community resources in assisting older adults and their families to retain personal goals, maximize function, maintain independence, and live in the least restrictive environment.

8. Assess family knowledge of skills necessary to deliver care to older adults.

9. Adapt technical skills to meet the functional, physical, cognitive, psychological, social, and endurance capacities of older

10. Individualize care and prevent morbidity and mortality associated with the use of physical and chemical restraints in older

11. Prevent or reduce common risk factors that contribute to functional decline, impaired quality of life, and excess disability
in older adults.

12. Establish and follow standards of care to recognize and report elder mistreatment.

13. Apply evidence-based standards to screen, immunize, and promote healthy activities in older adults.

14. Recognize and manage geriatric syndromes common to older adults.

15. Recognize the complex interaction of acute and chronic comorbid conditions common to older adults.

16. Use technology to enhance older adults’ function, independence, and safety.

17. Facilitate communication as older adults’ transition across and between home, hospital, and nursing home, with a particular focus on the use of technology.

18. Assist older adults, families, and caregivers to understand and balance “everyday” autonomy and safety decisions.

19. Apply ethical and legal principles to the complex issues that arise in care of older adults.

20. Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, and lifestyle on how families and assistive personnel provide long-term care to older adults.

21. Evaluate differing international models of geriatric care.

22. Analyze the impact of an aging society on the health care system.

23. Evaluate the influence of payer systems on access, availability, and affordability of health care for older adults.

24. Contrast the opportunities and constraints of supportive living arrangements on the function and independence of older adults and on their families.

25. Recognize the benefits of interdisciplinary team participation in care of older adults.

26. Evaluate the utility of complementary and integrative health care practices on health promotion and symptom management for older adults.

27. Facilitate older adults’ active participation in all aspects of their own health care.

28. Involve, educate, and when appropriate, supervise family, friends, and assistive personnel in implementing best practices
for older adults.

29. Ensure quality of care commensurate with older adults’ vulnerability and frequency and intensity of care needs.

30. Promote the desirability of quality end-of-life care for older adults, including pain and symptom management, as essential,  desirable, and integral components of nursing practice.


(American Association of Colleges of Nursing and the John A. Hartford Foundation Institute for Geriatric Nursing, 2000)