Page images
PDF
EPUB

Grade

(See fig. I for a reproduction of the scoring sheets.) The scoring system provides for a general evaluation of 13 equally important areas. The 13 scoring areas have been chosen with care, so that there is, we believe, a proper balance between the 3 large general areas of nursing, physical plant, and administration. Nursing has a dominant position, with six areas scored. The physical plant is scored in five areas and administration in two.

Minneapolis Scoring System for Nursing Homes

Kuf Points

Cude:

[blocks in formation]
[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small]

Includes general quality and amount of nursing supervision on all shifts, appraisal of the nurse in charge, details of the nursing service for which the nursing supervisor can be held responsible, delegation of duties, informing management of nursing supplies needed, personal relationships of nurse in charge with her staff, attending physicians, the visiting public, etc. Supervisory nurses' attitudes to their patients and their responsibilities, personal appearance, qualifications, control of time schedule for nursing personnel, participation in hiring and discharging of nursing staff, nurses' job descriptions and proficiency records.

Routine Nursing Practices

Includes appraisal of routine nursing practices, the quality and quantity of work
done by non-supervisory nursing staff, personal appearances of such staff, the
nursing standards used, the attitudes of staff nurses and orderlies to their
work and to their patients, methods of handling excretions, soiled linens,
use of nursing equipment, use of Kardex.

Treatments

Includes efficiency with which treatments are carried out, adherence to doctors' orders, handling of medicines, control of narcotics, sterilization of syringes, needles and other nursing equipment, maintenance of first aid equipment and treatment trays, serving of special diets, handling of feeders, changing of dressings, care of bedsores, use of restraints, etc.

Records

Includes appraisal of the adequacy of nursing admission records, nurses' notes,
doctors' diagnoses, doctors' notes, doctors' orders, narcotic records,
narcotic permit where applicable, security of records, etc.

Rehabilitation Nursing

Includes appraisal of the attention given to rehabilitation nursing, the attitudes of the staff to keeping people active and restoring function, the understanding of rehabilitation nursing, the quality and quantity of rehabilitation nursing practiced, the psychological response of patients, emphasis on recreation, use of gadgets and equipment, handling of partially disabled patients, bowel and bladder training, stimulation of patients' interests and activity, etc. In-service Training

Includes appraisal of the in-service training program being given by the nurse-in-charge, the curriculum, the participation of staff in any other nursing training programs, the frequency and freedom of staff meetings, the attitudes of supervisors and staff to the training programs, availability of nursing reference books, etc.

PHYSICAL PLANT AREA

Building

Includes the general suitability of the building, its general layout, maintenance,
toilets and lavatories, tubs or showers, plumbing, general storage space, wheel
chair storage, heating, lighting, ventilation, hand grips, hand rails, stairways,
halls, dayrooms, janitor's closet, laundry equipment, incinerator, closets
and clothing storage, stock linen storage, employees' quarters, dining room,
recreational area, screen doors and windows, elevators, illegal occupancy,
grounds and outbuildings, etc.

Fire Safety

Includes the fire resistive character of the building, sprinkling system, fire doors, fire alarms, fire exits, safe stairways, fire extinguishers, emergency lights, fire drills, safety of patient restraints, unsafe occupancy of upper floors, unnecessary clutter of attics and basements, etc.

(Only fire resistive structures can be rated excellent, sprinkling systems can be
rated no higher than average, less well protected must be rated unsatisfactory.)
Furnishings

Includes beds, bedside tables, chairs, bed screens, mattresses, bed linen,
side rails, wardrobes, walkers, wheel chairs, dayroom and diningroom furniture,
radios, television sets, maintenance of furnishings and bedding, etc.

Nursing Facilities and equipment

Includes utility rooms, bed pans, urinals, basins, catheters, nurses' supplies and
equipment, nursing station, medicine cabinet, refrigeration for biologicals,
sterilization equipment for nurses' use, bed pan sterilizer, facilities for
handling soiled linen and contaminated waste, local clean linen storage,
charting area, records file, Kardex, signalling system, nurses' lavatory, etc.
Kitchen and Food Service

Dcludes the location of the kitchen, its physical layout, ventilation, lighting,
facilities for tray service, food preparation, refrigeration, food storage, garbage
disposal, storage for dishes and trays, dishwashing, hand washing, condition
and adequacy of utensils, dishes, glasses and silverware, general cleanliness,
vermin and rodent control, methods of serving and handling of foods, menus
kept and followed, ability to prepare special diets, adequacy, appearance and
quality of meals served, appearance, cleanliness and techniques of kitchen and food
service staff, etc.

ADMINISTRATION AREA

Attitudes of Operator or Corporation Includes attitudes to and relationships with patients, nursing staff, other personnel, attending physicians, visiting public, volunteer workers, welfare workers, public health officials, etc. Interest in patient's health, comfort and welfare, interest in rehabilitation, occupational therapy, and patients' recreation, ability of operator to inspire confidence and loyalty, approachability, etc. Efficiency

Includes appraisal of the efficiency of management, familiarity with regulations, recognition of the responsibilities and limitations of management, ability of the operator to manage and work with his employees, delegation of authority, support of nurses and other personnel, control of housekeeping, control of waste materials; maintenance of supplies, food, equipment, grounds and buildings, personnel policies, personnel records, non-nursing staff work schedules, employment of adequate numbers of qualified staff, reaction to emergency situations, amount of time spent on duty, admission and discharge records, promotion of staff meetings, promptness in correcting deficiencies when brought to his attention, staff job descriptions and proficiency records.

Minneapolis Health Department
Revised 1/11/61

Consolidated in each of the 13 areas are many related functions and conditions, which are evaluated as to whether or not the area under consideration is, in general, unsatisfactory, satisfactory, or excellent. The items which are considered together in each area are detailed on the scoring sheet, so that the person making the evaluation will always have them before him, and consider them in their proper places. In the point scoring, satisfactory, or average performance, is given a score of one; excellent is given a score of two, while unsatisfactory is given a zero.

78681-62-pt. 5- -2

While the Minneapolis scoring system is a valuable evaluation tool, whether or not the total scores are converted into grades, it lends itself well to that purpose. For grading purposes a total score of from 23 to 26 points is used to designate a grade A nursing home, from 18 to 22 to designate a grade B home and from 11 to 17 to designate a grade C home. It should be noted that a total of 13 points represents an average of 1 point in each scoring area and at the same time 50 percent of the maximum of 26 points. On the basis of total points grade C represents the average nursing home while both grades B and A represent definitely superior nursing homes.

Grade CL, is used to designate a home falling into grade C, so far as scoring points are concerned, but which also has limitations on the type of patients which can be accepted. It is the practice to place all nursing homes not built of fire resistive materials, or equipped with a fire sprinkling system, into grade CL because in such homes only ambulatory patients are permitted above the ground floor, and we believe that no home of this type should be graded A or B.

Any home failing to score enough for grade C or CL is considered unsuitable for a nursing home but might qualify for some other license such as a boarding care home.

The range of points within the various grades is a feature which has definite value. It provides needed flexibility which lessens the possibility of error, reduces the necessity of comparing one nursing home with another, and makes possible scoring by different competent people without greatly affecting the final grade.

The range of points within grade A is sufficiently limited so that it is impossible to obtain grade A without an excellent nursing service, even with the maximum number of points in the general areas of physical plant and administration. It is also virtually impossible for an operator to establish a rating, in the upper half of grade C without a reasonably satisfactory nursing service. On the other hand it is possible for an administrator with the right attitudes and good nursing service to obtain a good score even with some deficiencies in the physical plant.

In scoring, the building is evaluated on the basis of whether or not it meets the requirements of the Minnesota Department of Health. Evaluation of the nursing service and administration is on the basis of whether or not the performance is what might be reasonably expected of an ordinary qualified persou in any ordinary nursing home.

The scoring is done by the author in consultation with the sanitarian who makes the building inspections and with the nurse-adviser who is devoting full time to nursing homes, with emphasis on improvement in the quality of nursing services. The fact that each of the homes is visited by one or more of this trio many times each year, makes the maintenance of up-to-date scores possible.

The Minneapolis scoring system does not establish a separate appraisal of what might be described as social activity, or the area of human relations. It does, however, recognize the importance of this aspect and does give it weight in appraisals of the attitudes of the supervisory nurse, the regular nursing staff and particularly of the attitudes of the nursing home administrator. The significance of this area is also reflected in the layout and furnishings found in the dayrooms and recreational ares.

THERAPIST BONUS POINTS

The use of physiotherapists and occupational therapists in nursing homes is rapidly gaining momentum and is a development which needs encouragement. We believe that the Minneapolis scoring system does give sufficient emphasis to this activity when it remains a merely interest-stimulating activity, but when a therapist is employed more than half time, the activity gets beyond an educational and recreational function into the field of specific therapy. In such instances, credit should be given for this extra service.

In assigning points for the employment of registered physiotherapists and occupational therapists one point is given for each full time therapist and onehalf point for a therapist serving from half time to full time. Points earned for therapists are placed in a special box on the score sheet called Therapist Bonus Score. It is felt that bonus points, for registered therapists, should not

be included in the regular score because development of this special area should not substitute for poor care, or poor conditions, in any 1 of the other 13 areas scored. Futhermore, when physiotherapy is provided, extra payment should be made for this service by, or on behalf of, the patient receiving it. In arriving at the final total which determines the grade, therapist bonus points are not counted but it is the practice to show their presence by adding a plus sign, to the regular total number of points, followed by the number of therapist bonus points. (Example: 24+12.)

MERIT BONUS POINTS

Under the Minneapolis scoring system, it is possible for a nursing home, by excellence in other areas, to attain a point score higher than the top of grade CL in spite of the handicap of a non-fire-resistive and unsprinkled building. According to established criteria, such a building cannot qualify for grade B nor grade A and is not permitted to have nonambulatory patients above ground floor. In other words, the grade has to be CL in spite of more than 17 points. Such a situation is taken care of by placing all earned points above the top of grade CL into a special area called a bonus score for merit. The presence of such merit bonus points is indicated by adding a plus sign, to the grade CL followed by the number of earned bonus points. (Example: CL+2.)

It is our feeling that any grade CL nursing home obtaining any merit bonus score should qualify to care for ground floor patients on the same basis as grade B nursing homes providing, of course, that such patients are cared for on the ground floor. In the statistical analyses in part 2 the beds on ground floor of such homes are classified as grade B beds.

It is the practice to send the nursing home administrator a complete copy of his score when it is originally made and a new copy whenever a change in grade is warranted. The number of points may fluctuate as significant improvement or deterioration takes place in any of the 13 areas. So long as the fluctuations remain within the same grade range, the change is recorded only in the files of the Minneapolis Health Department. It is the practice to keep the Minnesota Department of Health, the county welfare agency, and the city relief department fully informed. Administrators are encouraged to come into the office and discuss their grades and point scores at their convenience and they often do so. The Minneapolis scoring system has been found most helpful in discussions with administrators and nurses in charge. It makes easy the pointing out of weaknesses and strengths in a nursing home and assists both ursing home operators and health department surveillance staff in maintaining a balance of program emphasis.

The Minneapolis scoring system differs distinctly from most other known methods of evaluating nursing homes, because it primarily measures performance, in contrast to other certifications which are based on numbers of staff, education, hours of work, meeting licensing standards, etc. To us, the matter we are most concerned about is whether or not the patient is actually getting the care he wants, needs, and is paying for.

REFERENCES

1. Park, W. E., M.D., "Nursing Homes Speaking," Bulletin of Hennepin County Medical Society, vol. 29, November 1958.

2. Park, W. E., M.D., "Status of Nursing Homes in Minneapolis in Mid-1959," Bulletin of Hennepin County Medical Society, vol. 30, pp. 401-404, September 1959. 3. Moe, Mildred I., R.N., "Meeting the Challenge," Minnesota Registered Nurse, May 1960.

4. Park, W. E., M.D., "Highlights of the Minneapolis Nursing Home Surveillance Program," unpublished mimeographed materials, June 22, 1960. 5. Park, Wilford E., M.D., and Mildred I. Moe, R.N., "Rehabilitation Care in Nursing Homes," Public Health Reports, vol. 75, pp. 605-613, July 1960. 6. Moe, Mildred I., R.N., "Action Is the Goal," Professional Nursing Home, November 1960.

PART II.—EVALUATION, THE MEASURE OF PROGRESS

The strength of the Minneapolis scoring system lies in the fact that it measures performance. It reflects the quality of care the patients receive and the atmosphere of kindliness, or lack of it, which permeates the nursing home. To be sure, an element of personal feeling enters into any appraisal of people or their work performances. But this is a skill which is a characteristic of good personnel officers and interviewers, and one which can be effectively used in an evaluation of personnel and their work performance in a nursing home.

In Minneapolis the scoring of nursing homes is based on personal contacts with the homes and their staffs, which may be as frequent as 25 times a year. The contacts are frequently of such a nature that it is possible to learn a great deal about the attitudes, understanding, and ability of the people involved. During 16 months of use, the Minneapolis scoring system has given a dependable measurement of the effectiveness of the nursing home improvement program as is shown by the following graphs and charts. In all of the following tables and graphs adjustments have been made for new homes opened up and old ones closed, so that the figures given represent the situation on the dates indicated. The number of nursing homes by grades on five evaluation dates are shown in table I. The most notable change during the scoring period under review was in the grade A category. In 1 year and 4 months the number of grade A homes increased 41⁄2 times. In the same period grade C homes decreased 45 percent.

TABLE I.-Number of nursing homes in grades A, B, and C

[Includes adjustments for homes closed, reclassified, and new homes opened in the interval between

scoring dates]

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][subsumed][subsumed][subsumed][merged small][subsumed]

On September 1, 1959, 13 nursing homes were scored unsuitable; on January 1, 1960, 11 nursing homes were scored unsuitable; on May 1, 1960, 5 nursing homes were scored unsuitable; on September 1, 1960, 4 nursing homes were scored unsuitable; on January 1, 1961, 1 nursing home was scored unsuitable.

Of the original 13 homes unsuitable, on September 1, 1959, 4 have closed, 2 have become boarding care homes, and 6 have improved. The one remaining unsuitable will become a boarding care home on January 1, 1962.

Table II shows the same changes which are recorded in table I but in terms of the number of beds in the same homes by grades. The most dramatic change was in the number of beds in grade A homes where the increase was 720 percent. When it is realized that every one of these beds is available to a patient in need of nursing care the value to the community is very considerable. The decrease in beds in grade C homes was less spectacular (53.2 percent) but the shift of 614 beds from the average care category into better than average care is nevertheless very significant.

Another significant change which took place between September 1, 1959, and January 1, 1961, was the reduction of 13 unsuitable nursing homes to 1. This was brought about by sufficient improvement in six to raise them to a score of 11 points or higher, by reclassification of two to boarding care homes and by closing of four. It is expected that the one remaining unsuitable nursing home will be reclassified at the end of 1961. The number of beds in the nursing homes listed as unsuitable on September 1, 1959, totaled 236. January 1, 1961, through the changes mentioned, this number of beds has been reduced to one digit.

« PreviousContinue »