Recipe for aging gracefully
Marilyn Rantz
Adding to an already impressive body of work, Professor Marilyn Rantz recently netted the largest research grant ever in the school’s history. The National Institutes of Health awarded Rantz more than $3.1 million to continue her ground-breaking work on improving outcomes for nursing home residents.
Although she is considered an international leader in the nursing home care, Rantz is characteristically humble when asked about the advances she is making in the field. She says her new grant will fund work that “fits together” with her previous studies, which have been driven by Rantz’s desire to make life better for the nation’s elderly.
Through prior research, including a $2.5 million National Institute for Nursing Research grant, Rantz examined resident outcomes in order to classify nursing homes, identifying the most excellent facilities. She then sent teams of nurse researchers into more than 90 highly ranked homes to observe and describe the processes that result in outstanding resident care.
Their observations form the basis for Rantz’s new study, which will seek to bring the secrets of outstanding care to nursing homes that have less stellar resident outcomes.
“We found the facilities with very good outcomes were quite different from other nursing homes,” Rantz says. In particular, her team found that staff in outstanding nursing homes consistently provide excellent basic care, such as helping residents walk regularly, taking them to the bathroom when needed and offering good nutrition.
Yet care in outstanding homes goes beyond knowing the basics. Rantz found that staff organization and communication differed substantially between poor and good nursing homes. The best homes typically featured care provider teams who implemented quality improvement practices and made decisions about optimal individual care. In addition, outstanding homes tended to have less staff turnover and more stable leadership.
These findings led Rantz and her research team to develop a multi-level intervention that they will begin implementing this summer using the NIH grant. The team will work with nursing home owners, administrators, nursing directors and staff nurses on quality improvement processes, creating teams and honing the basics of care.
“It’s a very detailed program of working with staff to make changes in care delivery,” Rantz says. Participating facilities will be randomly selected.
Rantz will oversee the study at 56 homes. Two nurses will introduce the quality improvement intervention to half the homes while the others will receive regular visits from Rantz’s co-investigator, Mary Zwygart-Stauffacher of the University of Wisconsin, but will not use the intervention’s quality improvement measures. Staff at these control group homes will review physical assessment techniques based on a monthly multimedia presentation. All facilities will receive a standard educational manual. “We want to see if improved outcomes are just a matter of attention or if our specific intervention program is the key,” Rantz says.
The nursing homes that receive Rantz’s intervention will benefit from the research team’s coaching on staff team formation, professional management and quality improvement. Data on resident outcomes will be collected at several points over the next two years.
Rantz is confident nursing home administrators will welcome the opportunity to improve resident outcomes. Not only is it a matter of good care, but it’s a matter of good business, she says, having found that homes with better outcomes are also more cost effective.
“We can help them learn how this works, and it will save them money,” she says. Rantz attributes this cost-saving phenomenon to the fact homes with outstanding outcomes tend to have less staff turnover, which reduces hiring and training costs.
“Good care leads to better resident function,” she adds. “It’s less expensive to maintain people’s abilities than it is to let people weaken and then have to provide more care.” For instance, residents who are encouraged to walk are able to care for themselves better, requiring less nursing care. More independent, healthy residents also decrease supply costs for such things as incontinence products and nutritional supplements.
Rantz predicts some nurses in the homes participating in the study will embrace the new procedures presented by the research team.
“Nurses who like working as a team and have some experience in groups will fit in well with the intervention,” she says. However, as is the case with any major change, some individuals are likely to resist the innovations. “It really just depends on their experience,” Rantz adds. "e;Health care, in general, often uses a team approach to patient management, but nursing homes have been historically hierarchical, so this could be a major shift for staff who have spent a long time in the nursing home industry.”
Despite the risk of resistance, Rantz is convinced the team strategy found in her previous study’s best nursing homes will improve care at other sites. “Top-down communication is probably more prevalent than using a team process in nursing home management,” Rantz says. “We want to teach them some new tricks.”
Rantz conducts her work in cooperation with several other researchers from a variety of disciplines. She’s also a multi-project researcher with several other studies underway, including research on technology in nursing homes using hand-held computers and a consumer guide to quality nursing home care.
In completing the nursing home quality guide, Rantz enthusiastically describes the instrument her team developed over the course of the last decade, which will allow consumers, regulators and researchers to better assess nursing homes.
“Our instrument correlates with the state’s existing survey findings on nursing home quality,” she notes, explaining that the state routinely sends regulators into nursing homes to assess quality. Nursing homes that are found to have deficiencies work with state survey teams to address the problems.
“Our instrument could be used by regulators to abbreviate the survey process and save state money,” Rantz explains. “That’s important because our state surveyors are stretched to their limits. This instrument will offer a faster alternative.”
While the academic and professional communities benefit from the processes put in place through Rantz’s work, the state’s elderly stand to gain the most from the efforts of this one dedicated researcher.