Archive for Friday, December 19, 2008

Nursing home industry worries about new five-star ratings

December 19, 2008

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LeeAnn Blevins, left, director of activities at Regal Estates in Independence, Kan., assists Bruce Williams with blowing bubbles while residents Bonnie Bynum, Jayne Swepston, Vera Woods and Rose Bramble watch a giant bubble created by middle school students float by in this 2006 file photo.

LeeAnn Blevins, left, director of activities at Regal Estates in Independence, Kan., assists Bruce Williams with blowing bubbles while residents Bonnie Bynum, Jayne Swepston, Vera Woods and Rose Bramble watch a giant bubble created by middle school students float by in this 2006 file photo.

— 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. 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.

‘Transparency is key’

Officials also see the new rating system as a way to challenge nursing homes to improve the care they provide to nearly 1.5 million patients nationwide.

“Transparency is key when it comes to nursing home quality,” said Sen. Herb Kohl, D-Wis.

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 industry is already questioning their validity.

To nursing home operators, the five-star system is a great idea whose time has not yet come.

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.

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.

Lawrence reaction

Rhonda Parks, executive director of Lawrence Presbyterian Manor, said the system is simple and straightforward, but that users need to be aware that the data can be misleading. For example, she said the score on quality measures could look bad, but the nursing home may have taken on some challenging health conditions. As a result, they may be docked for simply trying to help someone.

Lawrence Presbyterian scored four stars overall, which tied for the most given among the four Lawrence nursing homes listed on the Web site. The other one was Lawrence Memorial Hospital’s Skilled Nursing Facility.

Parks said she was appreciative that the overall score reflected the nursing home’s history for being in compliance and having good survey records. But, she said, it’s just one piece of information. It shouldn’t replace talking to trusted health professionals in the community and making a personal visit.

“You cannot take the place of those personal visits,” Parks said. “If a facility tries not to provide that opportunity for a prospective person, then you know something is probably not right. Plus, when you just go in and see the interaction with the staff and residents and how it feels and the ambiance and how it all just comes across, that is real important.”

Data problems

Consumer groups also 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.”

Hedt said consumers should consider the star ratings, but not solely rely on them when comparing facilities. Her organization also warned that nursing homes may appear in the ratings to give better care than they actually do.

— Health and environment reporter Karrey Britt contributed information to this story.

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