The University of California, San Francisco, is collaborating with other universities to develop a standard of care in nursing homes

UCSF researchers want to change the way medical care is delivered in nursing homes across the nation, resulting in better health outcomes, and lower costs.

Americans spend more than $103 billion a year on nursing home care, an amount that is expected to rise quickly as baby boomers age during the next two decades. However, researchers at the University of California, San Francisco School of Nursing will launch a study in 2008 to create a new model of care in nursing homes. The result is expected to save lives, and money.

The Atlantic Philanthropies of New York City granted $1 million for the five-year project, which includes another $75,000 for the initial year planning phase that recently started. Charlene Harrington, PhD., a UCSF professor of nursing, leads the collaborative project with Margaret Wallhagen, PhD, the director of John A. Hartford Center for Geriatric Nursing Excellence. Other centers involved with the study include Oregon Health and Science University, Universities of Iowa, University of Arkansas, and University of Pennsylvania, are coordinating with UCSF and splitting the grant.

"It's no secret that our nursing homes are struggling to provide the care that our seniors need and deserve," said Harrington. The researchers intend to find "tangible methods and practices to improve nursing care in order to achieve better outcomes," she said. The team will use peer-reviewed research into what works and what doesn't.

Recent studies demonstrate that adding nurses and licensed vocational nurses at nursing homes, as well as increasing staff interaction with patients, reduces the number of senior hospitalizations and emergency room visits, according to Eric Collier, RN, the UCSF project coordinator. Collier said a study published in Health Affairs shows "tremendous revenue savings for Medicare" when nursing homes have a higher number of nurse practitioners.

Conditions such as diabetes, pneumonia, and bedsores can be "managed more effectively" with more direct care, according to Collier. The model project will use "progressive human resources policies," he said, in which staff members have more opportunity for advancement as well as more say in the quality of care practices, to cut costs and hospital visits.

Nationwide, turnover for nursing assistants average about 65 percent, while rates for licensed vocational and registered nurses runs about 50 percent. This job dissatisfaction significantly affects continuity of patient care, according to Collier.

About 30 UCSF employees will work on the study, which Collier said should "provide evidence for interventions." The goal is to use "a kinder, gentler approach" to managing staff by involving nurse practitioners, direct care providers, and human resources managers in creating a more humane environment, said Collier. The steering committee includes representatives from the American Association of Retired Persons and other national health organizations, as well as academic advisers.

By adding more nurses and improving quality of care and leadership, the practice model should "prevent problems common in nursing homes like weight loss, falls, dehydration, a whole series of things that happen to patients if they don't have enough nursing care," said Harrington. Currently, the team is looking at possible sites to use. The planning stage should be finished by June 30, 2008.

Nationally, there are approximately 17,000 nursing homes with more than 1.7 million residents, Wallhagen said. She noted that Institute of Medicine panels have called for major reforms in nursing home care delivery. "The time has come to better synthesize and utilize" knowledge that nursing home care of seniors can be improved," she said.

The UCSF team is also collaborating with the Aging Services of California, the California Association of Health Facilities, the California Culture Change Coalition, the California Healthcare Foundation, and Lumetra, a quality improvement organization and colleagues from Vanderbilt University and the University of California, Irvine.

—By Eren Goknar

Eren Goknar is a freelance journalist in Mountain View.