To the Editor,
I found Nate Procter’s story on Dr. David Grabowski’s talk on the challenges and potential solutions regarding nursing home care in the United States very interesting and informative.
As someone who has worked in nursing homes both as a certified nursing assistant and as a registered nurse, I can attest to the truth of Grabowski’s contention that quality is a long-standing issue. He is to be commended for his efforts to improve nursing home care quality. Grabowski has studied three different models in order to better understand how current economic ideas might be applied to nursing homes: pay-for-performance, report cards and integrated models of care. According to Procter’s story, Grabowski relayed that neither pay-for-performance nor report cards work very well, but did not discuss the characteristics of integrated models of care.
I would like to draw your attention to the organization I work for, Commonwealth Care Alliance (CCA). CCA is a non-profit, community-based healthcare organization dedicated to improving care for individuals who are dually eligible for MassHealth (Medicaid) and Medicare with complex medical, behavioral health and social needs, including persons with disabilities.
Due to the fact that our integrated model of care is primarily nurse and nurse practitioner-driven, we bring the strong nursing perspective to care. Our practice also includes medical doctors, physician assistants, social workers, community health workers and physical and occupational therapists. There are nurse practitioners that specialize in diabetes, wound care, palliative care and a host of other fields, on whom we can call as needed. Additionally, CCA has transitions of care nurses who help patients make a safe transition from home to hospital, crisis center, rehab or nursing home and back, whether temporarily or permanently. We have emergency medical technicians with specialized training who see patients in their homes and have dramatically reduced the number of emergency department and hospital admissions.
Space limitations preclude my giving more detail, but any reader who cares to know more is welcome to visit our website. There you may read the comments of our patients and their positive experiences with our integrated model of care. Although our model is designed for keeping those with disabilities living independently and in their communities, I believe it could be adapted to other contexts, such as nursing homes.
Rachel Diamondstone
Ph.D. Candidate
UMass College of Nursing
