Marilyn Rantz
May 25, 2016
The views and opinions expressed in this “for expert comment” release are based on research and/or opinions of the researcher(s) and/or faculty member(s) and do not reflect the University’s official stance.
Quality of care in nursing homes has long been under scrutiny of the public and government regulators. Under this microscope, how can nurses improve quality of care in nursing homes? That question has laid the research foundation for Marilyn Rantz, Curators’ Professor Emerita of Nursing in the Sinclair School of Nursing at the University of Missouri. Over the past 30 years, Rantz has established herself as a premier international expert in quality measurement in nursing homes and research programs to improve quality of care of older people. Through her research she has found that nurses, coordinated care and technology all play pivotal roles in improving patient care and lowering health care costs for aging populations.
“In my 40 plus years working in health care, as an administrator, a registered nurse and a researcher, I have found aging in place to be the best model for seniors, both economically and in terms of patient care,” Rantz said. “Aging does not mean that you suddenly lose your independence. We are seeing great results from our research on aging-in place-models that allow seniors to remain independent as long as possible while ensuring they also remain healthy. These models are successful in large part due to those on the frontlines of care—the nurses.”
Coordinated care in aging in place facilities includes incorporating the fundamentals of care as means of improving program quality. The fundamentals of care—walking, nutrition, hydration and toileting—have been found to improve overall health outcomes for nursing home residents. In a study conducted by Rantz, facilities that encouraged staff to prioritize the fundamentals of care had much better health outcomes than those that did not. Best practices included staff walking with residents and presenting food in an attractive manner that encouraged residents to eat.
Rantz’s research also has found that when advanced practice registered nurses (APRNs) are allowed to practice independently and when they can perform primary care duties to their full potentials, quality of health care across states is improved. APRNs have graduate-level educations and advanced knowledge of the best evidence-based practices. The Missouri Quality Initiative for Nursing Homes, a Centers for Medicare and Medicaid (CMS) Innovations-funded program Rantz leads, is aimed at improving healthcare in 16 long-term care facilities in St. Louis. The program provides full-time APRNs who work in each facility to coordinate care and help staff detect health changes early. In the four years since the program launched, the facilities have seen a 34.5 percent decrease in potentially avoidable hospitalizations, allowing more residents to age in place.
TigerPlace, an innovative aging-in-place retirement residence, located in Columbia, Mo., was developed by Rantz as a way to demonstrate her research on how to improve long-term health care. TigerPlace is a residential community that is a service, research and practice environment where people make their homes. TigerPlace also utilizes video game technology, motion sensors, a hydraulic bed sensor under the mattress and at times new radar systems to detect illness and prevent falls. Studies on this technology have found that residents living with technology stayed longer at TigerPlace if technology was used to assist their care. Using a public-private partnership model, care at TigerPlace is provided by the Sinclair School of Nursing. Facilities and services are managed by Americare Systems, allowing everything that residents may need to be accessible in one place.
“Moving people from place to place is harmful,” Rantz said. “Nurses are able to provide necessary care for common ailments, such as pneumonia, to help keep older people out of hospitals. When facilities that allow for aging in place, such as TigerPlace, provide coordinated care, all services are accessible which prevents older people from being moved from location to location depending on the services needed.”
These efforts are not only beneficial to nursing home residents, but they also are economical. Past research has found that long-term care facilities can see significant savings after implementing a quality care improvement program. In Missouri alone, Rantz’s research indicated that facilities saved more than $6 million over a three-year period, in part from preventing hospitalizations.
“Effective care does not happen by chance or by simply working harder,” Rantz said. “It requires a coordinated effort from various disciplines and it requires innovation, using new tools and new technologies to help seniors remain independent. Moreover, it requires everyone from administrators to service providers to be on the same page. Of those involved, nurses, specifically APRNs, are able to play a critical role in making sure nursing home residents are getting the best care.”
Rantz is a member of the Institute of Medicine, is the executive director of Aging in Place at TigerPlace as well as the Associate Director for the Interdisciplinary Center on Aging. She serves as the University Hospitals and Clinics Professor Emerita of Nursing and as the Helen E. Nahm Chair from 2008-2015 within the Sinclair School of Nursing.
