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Quality of Care


Community Living Center Health Surveys

Health Surveys

Medicare Certified Skilled Nursing Facilities as well as VA Community Living Centers must meet standards set by the federal government to protect residents. Examples of these standards include:

  • Hiring enough quality staff to provide adequate care
  • Managing medications properly
  • Protecting residents from physical and mental abuse
  • Storing and preparing food properly

State survey agencies conduct health surveys of Medicare certified facilities about once a year on behalf of the federal government. The health survey team consists of trained surveyors, including at least one registered nurse. VA uses an external organization to survey its CLCs using the same standards required by Medicare. VA’s survey team looks at many aspects of life in the nursing home including, but not limited to:

  • The care of residents and the processes used to give that care
  • How the staff and residents interact
  • The nursing home environment

Surveyors also review the residents' clinical records, interview residents and family members, as well as caregivers and administrative staff.


There is significant evidence of a relationship between resident outcomes and staffing levels in nursing homes. Staffing levels are evaluated using information about the number of hours of care provided on average to each resident each day by nursing staff, which include registered nurses (RN), licensed practical/vocational nurses (LPN/LVN), and nurse aides (NA). Care hours are derived from automated systems that track staff assignments and care. Total care hours are adjusted for the fact that some residents are sicker and therefore have greater care needs. For example, a Community Nursing Home with residents who had more severe needs would be expected to have more nursing staff than one where the residents do not need as much care. VA CLC staffing measures can be viewed here.

Quality Measures

A set of quality measures has been developed from Minimum Data Set (MDS) and Medicare claims data to describe the quality of care provided in nursing homes. These measures address a broad range of function and health status indicators. This information is collected by VA Community Living Centers as well as by Medicare Skilled Nursing Facilities for all residents using the latest version of the Resident Assessment Instrument - MDS. The information collected includes the residents' health, physical functioning, mental status, and general well-being and offer information about the progress of resident’s physical and clinical needs. Medicare Skilled Nursing Facilities and VA CLCs use the quality measures to review and improve the quality of the care they give to residents. Information is listed for 2 groups of residents:

  1. Short-stay residents - those who spent 100 days or less in a nursing home
  2. Long-stay residents - those who spent over 100 days in a nursing home

CMS assigns nursing homes a quality of resident care star rating based on their performance on 16 measures, of which VA currently is able to track and report 11. The other 5 are in development and will be released when available.

Quality Measures are not the same as Quality Standards

According to Medicare Nursing Home Compare the quality of resident care measures aren’t benchmarks, thresholds, guidelines, or standards of care. They are snapshot, at a point in time, of the average condition of residents. The measures also may not take into account the special populations that are served by a facility, which may cause higher rates of certain conditions. For example, a CLC that specializes in complex skin and wound care may admit Veterans with severe pressure ulcers that occurred at home or another hospital. If those residents require more than 100 days for healing, those residents will be counted in the numerator of the “Pressure Ulcer among High Risk Long Stay Residents” measure, even if their care in the CLC was entirely appropriate and met medical standards.

Nursing Home Compare Data

How Does Care Compare in VA and Other Facilities in My Area provides Information about the quality measures used in rating the performance of VA CLCs. The site includes an interactive, searchable map that can be used to locate CLCs by ZIP code or distance. Detailed information on individual quality measures and how VA-contracted nursing homes compare to VA CLCs can also be viewed.

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