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Top 5 quality issues in nursing homes

Posted by Bianca Beentjes on January 5 2017
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The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050. Many of the very old lose their ability to live independently and require some form of assisted living. The need for long-term care, including nursing homes, is rising.

Only in Canada there are currently more than 1.360 nursing homes, providing care for approximately 143.000 Canadians. Many of the bigger challenges within nursing homes are quality related. For example, fall incidents, which is a major safety concern for nursing facilities.

Statistics show that a typical 100 beds facility reports up to 200 fall incidents a year. In reality this number is much higher because a lot of fall incidents goes unreported. Up to 20% of the falls result in serious injuries, and sometimes even death. According to the WHO an estimated of 422.000 individuals die from falls globally each year!

The financial costs from fall-related injuries are substantial. Falls were the leading cause of overall injury costs in Canada in 2010, accounting for $8.7 billion. When Canadians aged 85 and over, the per capita costs rise significantly to $1,885.

This blog describes 5 common issues nursing homes have to deal with in order to properly organize quality management. Thereby we provide a practical solution to these challenges, based on a case study of the New Brunswick nursing homes.

1. Lack of legislation 

Within the hospital segment there is law and legislation present that secures a tremendous focus on quality and patient safety. But within the nursing home segment it is another story. In most countries there is no law or legislation that oblige nursing homes to have a proper quality management system in place. This makes quality management more a nice to have instead of a must have.

2. Paper based vs online registration

Nursing homes often rely on paper to register incidents. Incident management seems to be more of ad hoc administration.

Paper based registration however comes with many disadvantages:

  • No reporting due to cumbersome process.
  • Does not support communication between the risk/quality department, managers and front-line staff.
  • Increased risk of inaccurate reporting, resulting in ineffective improvement actions.
  • No monitoring of turnaround times, resulting in no timely follow-up of incidents.
  • Takes a lot of time to analyze incidents and create management reports. Time that could be used to improve the quality of care.

3. Many small incidents go unreported

It’s is important to recognize the impact of reporting small incidents such as a bruise, a pinch or a cut. The insights that are collected from small incidents help identify where corrective actions are required

to prevent major/critical incidents from happening. By registering more incidents, you have more data to analyze and more improvement actions that could be initiated. Achieving continuous improvement improves the care and provides the possibility to share lessons learned.

But how can you create an environment that encourages staff to report also the minor incidents and mistakes so that weaknesses in existing processes are discovered? You can read more about it in our e-book about Just Culture.

4. Incidents are related to staff as well as residents

Most of the nursing home incidents relate to a resident as well as an employee. For example: A residents falls out of bed. An employee helps the resident back into his bed, but strains her back while lifting the resident. This incident encompasses 2 types of incidents: a resident related incident (the client falls out of bed) and a staff related incident (the employee strained her back).

If an incident is reported, it is reported either for the resident or the employee. But not for both. So, an essential part of the information is missing, resulting in a lack of valuable insights.

And if both types of incidents are reported, they are reported in two different systems/ways. In this way, the relation between the two incidents is still not clear.

Only one (online) integrated quality management system that manages both information streams will make sure that no essential information is missing and that the relation between both incidents is discovered.

5. Limited budget

However, small nursing homes commonly have a limited budget. Which could make an online integrated quality management system unaffordable.

Case study: The New Brunswick Association of Nursing Homes

Michael Keating, now retired Executive Director of the New Brunswick Association of Nursing Homes (NBANH), recognized these 5 quality related issues within the nursing homes and realized it was time for a change! Michael tells: “Three years ago, we were the most dangerous place to work in New Brunswick.”

A project was initiated to help the nursing homes creating a safer workplace without sacrificing the quality of care for their residents. The project included an integrated system for reporting and managing incidents. The system was the answer to all the quality management issues mentioned above.

However, also the nursing homes of New Brunswick had to deal with limited budgets. So, they came up with a unique solution: The nursing homes share one quality and risk management platform. Besides the financial benefits, sharing a platform has valuable advantages, like benchmarking possibilities and sharing lessons learned.

The project was unique in its kind. The launch of the project did not go unnoticed and received national media attention. We bundled some of the publications into a media report:

Download media report


Canadian Institute for Health Information. (n.d.). When a Nursing Home is Home: How do Canadian Nursing Homes measure up on Quality? Retrieved from

Canadian Institute for Health Information. (n.d.). Health Spending - Nursing Homes. Retrieved from

Parachute. (2015, June). The cost of injury in Canada. Retrieved from

Vesterinen, A. (2016, April 25). 7 Reasons why incident reporting is indispensable. Retrieved from

Wieand Law Firm, & Wieand, B. (2016, August 18). Nursing home fall accident statistics reveal thousands of annual deaths, injuries to seniors. Retrieved from

World Health Organization. (n.d.). Are you ready? What you need to know about ageing. Retrieved from 

Topics: Nursing homes, Quality issues

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