(P28) Relationship Between Nursing Home Quality Rating and Pain in Dementia

Introduction/Objective: Pain is highly prevalent among nursing home (NH) residents with dementia. Estimates suggest 35-80% of NH residents with dementia experience pain. Pain had been identified as a quality indicator used to measure NH performance. The Center for Medicare and Medicaid Services (CMS) Five-Star Quality Rating System is intended to inform the public of NH quality metrics. There should, therefore, be evidence that facilities with higher star ratings provide better pain management resulting in lower odds of having residents showing signs of pain.

Design/Methodology : This cross-sectional secondary data analysis used baseline data from an implementation study testing the impact of an intervention to manage behavioral symptoms in NH residents with dementia. The sample included 553 residents with dementia living in 55 NHs. Generalized linear mixed models (GLMM) were used to test the relationship between CMS five-star rating and pain controlling for comorbidities, cognition, and profit status.

Results: On average, NHs in the sample had a five-star rating of 3.5 (SD= 1.3) and pain was observed in 22.6% (n=125) of the sample. Five-star rating was significantly associated with pain such that the odds of having pain among residents with dementia decreased by 34.8% for each unit increase in star rating, after controlling for cognition and comorbidities of residents and facility profit status (Adjusted OR: 0.651, 95% CI 0.450- 0.941, p= 0.023)

Conclusion/Discussion : Findings suggest that a higher star rating is significantly associated with the relationship between a NH’s CMS five- star rating and pain among residents with dementia. NH’s with low CMS five-star ratings may need increased focus on pain management for residents with dementia.
Future research is needed to examine other factors on NH organizational level and beyond that influence pain in residents with dementia.