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December 26, 2008

Local nursing homes split over rating system

From Staff Reports

Some local nursing home administrators are skeptical about the reliability of the new five-star rating system unveiled last Thursday.

“The only way someone is going to know is to visit each one,” Cedar Lake Nursing Home & Rehab Administrator, Director of Operations Douglas “Sonny” Humble said. “Go see if everybody’s hair is combed, nails are done and everyone is smiling that works there.”

About 22 percent of the nation’s nearly 16,000 nursing homes received the federal government’s lowest rating in a new five-star system unveiled Thursday, while 12 percent received the highest ranking possible.

A home could obtain up to five stars based on criteria such as staffing and how well they fared in state inspections. The lowest ranking possible was one star.

Under the new system, five stars means a nursing home ranks “much above average,” four star indicates “above average,” three means “about average,” two is “below average” with a one indicating “much below average.” The rankings will be updated quarterly.

The ratings are based on three major criteria: state inspections, staffing levels and quality measures, such as the percentage of residents with bed sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.

Windsor Health, of Chandler, Administrator Benjamin Delmonico said the surveys the rating is based on is only a snapshot.

“Surveyors come in at least once a year for three or four days,” he said. “I don’t feel it is a full accurate picture.”

Delmonico said the system the ratings are based on should be improved.

Administrator for South Place Nursing Home in Athens, Hugh Adams said they are in favor of the system.

“It levels the playing field,” he said. “When someone comes to the facility they are better prepared.”

South Place received a five star rating, according to Adams.

Cedar Lake has received four out of five stars, according to Humble. He said it received the highest ranking in quality, and the lowest, three stars, in inspection rating and staffing.

The rating for Windsor Health was not available.

“I don’t know how accurate it is but it is more simple to understand,” he said. “I think they should put their eyes on each individual facility they want to put their mother into.”

Such a simple rating for so complex a task as caring for the elderly has led to much anxiety in the nursing home industry.

Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said the agency was merely taking existing data already on the agency’s Web site and making it easier for patients and families to evaluate a nursing home. He said it can be difficult for people to understand all the aspects of an inspection.

“This should help consumers in narrowing their choices, but nothing should substitute for visiting a nursing home when making a decision,” Weems said.

The system “is poorly planned, prematurely implemented and hamhandedly rolled out,” said Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging, an industry trade group.

Consumer groups like the concept, but agreed there are some potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely recognized as unreliable.

“From a consumer viewpoint, it’s not stringent enough,” said Alice H. Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform. “It’s basically taking information already available on Medicare’s Nursing Home Compare Web site and pulling it into an easier system for consumers to use, and that is a good thing.”

CMS used three year’s worth of inspections to rate nursing homes based on an annual survey designed to measure how well homes protect the health and safety of their residents. The measurement for staffing reports the number of hours of nursing and other staff dedicated per patient each day.

Humble said the ratings can be misleading because a nursing home with 20 patients could get a high rating over a facility with more patients.

The measurement for quality looks at 10 areas, including the percent of patients with bed sores after their first 90 days in the nursing home and the number of residents whose mobility worsened after admission.

“The ratings are over-rated,” he said. “You have to know all the ins and outs of why the ratings are the way they are.”

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