When Florence Bolella, director of nursing at Kimberly Hall South nursing home in Windsor, told her staff to remove all the alarms from patients, fear and panic set in. Not among the residents, who were relieved to be free of the annoying beeps and squawks that sounded every time someone with mobility problems moved, but among the nurses’ aides. “The CNAs were so afraid they were going to get in trouble if a patient fell,” Bolella recalled. “It took us almost a year to remove 33 alarms. I eventually had to lock up the alarms, so the staff would stop using them.”
In the two years that the nursing home has stopped using both alarms and restraints, it has seen a decline in the number of falls. Bolella isn’t surprised: “I never felt the alarms were effective.”
Kimberly Hall South is among a handful of nursing homes in Connecticut that have gone “alarm-free,” meaning residents at risk of injury, usually from falls, are no longer outfitted with detectors on their mattresses, chair pads and clothing that emit a warning signal when they try to get up and move around.
Connecticut has saved an estimated $5.4 million in Medicare costs since 2010 by reducing re-hospitalizations of patients through a collaborative “communities of care” model in place in 14 regions around the state, including Hartford, New Haven, Milford, Meriden and Torrington. The estimate by Qualidigm, the state’s Medicare quality improvement organization, coincides with a study in the Journal of the American Medical Association (JAMA) that showed a marked decrease in both hospitalizations and readmissions of Medicare patients in regions where quality improvement organizations (QIOs) coordinate interventions that engage community partners to improve care after discharge. Hospital clinicians and their community partners in the 14 regions of Connecticut have stepped up “to find solutions (so that) patients are benefitting from enhanced coordination among providers across the care continuum,” said Dr. Mary Cooper, vice president and chief quality officer of the Connecticut Hospital Association, which is working with Qualidigm on the “communities of care” model. Readmitting Medicare patients to the hospital within a month of discharge is a frequent—and expensive — occurrence. A new report published this week by the Robert Wood Johnson Foundation shows that hospitals and their community allies made little progress from 2008 to 2010 at reducing readmissions for elderly patients.
The Westside Care Center in Manchester is ranked among the best nursing homes in Connecticut, receiving a ‘five-star’ rating for overall quality under a federal rating system. At the same time, Westside has the state’s highest percentage of residents who receive antipsychotic drugs, even though they do not have a psychosis or related condition that regulators say warrants their use. Federal data shows 68 percent of Westside long-stay residents were receiving the drugs – more than double the state’s average of 26 percent, which already ranks in the top-third of states nationally. A C-HIT review of federal nursing home data from December found that Westside is not alone: High antipsychotic use, considered dangerous and unnecessary in many cases, does not impact quality ratings of nursing homes, and is often unknown to consumers selecting a home. In three-dozen Connecticut homes, at least a third of long-stay residents are on antipsychotics – yet nearly half of those homes have excellent overall ratings, of 4 to 5 stars.