OPTIMISTIC and Beyond: Programs to Improve Nursing Home Care and Reduce Avoidable Hospitalizations

Nursing homes, which provide both postacute care and long-term care, are critical sites of care for geriatric patients. People who receive care in nursing homes have some combination of cognitive impairment, functional limitations, and/or serious, complex illness. While there are differences among nursing homes, such as size or quality rating, they operate under the same financing mechanisms (largely Medicaid and Medicare) and federal regulatory frameworks. A 2022 National Academy of Sciences, Engineering, and Medicine report focused on improving nursing home quality found that “the way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented and unsustainable…the current system often fails to provide high-quality care…” [1]. The COVID-19 pandemic had a devastating impact on nursing home residents and the industry as a whole, highlighting many of the challenges in this setting of care. Within this system, which many have referred to as “broken,” researchers and clinicians continue to collaborate and innovate with the goal of improving the quality and safety of care for nursing home residents. In this chapter, the experience of the OPTIMISTIC—Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care—clinical demonstration project is described, including implications for implementation and policy [2].