USA Today reported that more than 560 of the nation’s nursing homes have not improved care for the past three years from a one-star federal government rating — the lowest on a five-star scale — even though most homes improved, according to a USA TODAY analysis of federal data.  See ratings for nursing homes.

The lowest overall rating is awarded to homes "much below average" compared with others in their state, according to CMS.   The star ratings are part of a broader federal effort to increase transparency for consumers of health care.  The federal government contracts with states to inspect nursing homes about once a year. The star ratings combine scores of data points, including information from annual inspections, quality measures and staff time spent with residents.

USA TODAY analyzed the ratings for 15,700 nursing homes for the past three years. Among the findings:

•Some homes are stuck at the bottom: 564 homes — representing 77,315 beds — received one star in each of seven reporting periods analyzed over three years. But 448 homes received the best overall rating — five stars — during each period.

Among the consistently low performers, almost two-thirds were for-profit nursing homes that are owned by chains. That’s a higher share than the 40% of all nursing homes in for-profit chains.

Lower staff turnover can create better care because employees become familiar with the routines and needs of nursing home residents.

.

 

The Evansville Courier & Press had an article written by Hanns Pieper is professor of sociology and gerontology at the University of Evansville regarding staffing.  He refers to Medicare.gov which contains nationwide nursing home comparison data.

"Staffing time measures are especially important because it’s the staff that actually delivers the care. The data are based on the nursing home’s staffing hours during the two weeks before the inspection and represent the average amount of time available per resident. All other things being equal, the more time per resident the better."

CNA data is the most important since they provide 90-95% of the direct care to residents.  CNAs have the most frequent contact with the residents, so the time they have available is key.  The time available measure is an indicator of staffing adequacy and there often is a significant difference among the different star ratings.

He looked at a list of Indiana nursing homes, and randomly selected a nursing home with a 4-star rating and one with a 1-star rating for staffing.  The 4-star nursing home provided almost an extra hour per day per resident.

There are other important indicators of staffing adequacy that are not presented in the charts such as staff turnover, and call bell response time.   Data that shows how many CNAs who were working on Jan. 1 and still were employed on Dec. 31 should be available.   A CNA’s leaving often has a significant emotional impact on residents. The quality of care is affected. A high turnover rate also may be an indicator of other inadequate conditions in the nursing home.

The time it takes for a staff member to respond to call lights/bells requesting assitance made by a resident is also not presented in the data.  When facilities don’t have an intercom to determine if the situation is an emergency or routine event, a long response time can lead to devastating results. Inrercom systems and electronic recording of alarms and call bells should be standard in most nursing homes.
 

USA Today had a great article on the excessive number of nursing homes that receive taxpayer money but refuse to meet the minimum requirements for quality of care.  The requirements are basic and necessary services, and fundamental safety and food standards. Personal hygiene, responding to call bells, fresh foods, hot water, taking vital signs, etc—-basic stuff but because of greed and short-staffing one in five of the nation’s 15,700 nursing homes have consistently received poor ratings for overall quality.

More than a quarter-million patients live in homes given another set of low scores within the past year, according to data released today by Medicare, which first released the star ratings of the nation’s nursing homes in late 2008. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009.

USA TODAY found that all 50 states and the District of Columbia have homes with poor ratings from one year to the next.  And dozens of those facilities are the only nursing homes for miles.

Late in the Bush administration, the Centers for Medicare & Medicaid Services began assigning nursing homes one to five stars for quality, staffing and health inspections, as well as an overall score. Nearly all homes that repeatedly received few overall stars — one or two stars — were owned by for-profit corporations, the data show.

"The issue is the owners have to take responsibility for the consequences" of poorly performing homes, says Larry Minnix, CEO of American Association of Homes and Services for the Aging.

The newspaper’s analysis found the lowest-rated homes had an average of 14 deficiencies per facility, which can include quality-of-life measures and safety violations.

We have many people call us asking for advice on how to choose a nursing home. Many of the people seeking advice want to rely on Medicare’s star ratings.  We are not convinced that these star ratings give an accurate assessment of a nursing home’s ability to provide good care.  The ratings are primarily based on surveys and investigations done by the Department of Health and Environmental Control (DHEC).  Well, the problem with that is DHEC tells the facilities when they are going to investigate or conduct a survey giving the facilities time to get their best nurses in the facility, to staff more than typical, and make sure all the documentation is revisited and changed if lacking.  

When abuse or neglect is reported, the state’s investigations procedurally favor the facilities. Violations must be actually found in the facilities’ own documentation, which are very self-serving. We cannot rely on the state for enforcement of regulations that are designed to protect residents and ensure proper care.

The key to quality of care is competent, compassionate, and well-trained staff.  They are less likely to get burnt-out and more likely to stay in the job thus lowering turnover rates which are detrimental to residents especially those with dementia.  The reality often is that staff who complain about resident neglect don’t remain employed.  Fortunately there are laws to protect workers from retaliatory firing, but many employees still fear losing their jobs by speaking up.  Regulations exist to protect residents from neglect, but residents and employees fear retaliation. Many times families aren’t aware neglect is occurring. Facilities lie and cover up to protect themselves from liability.

There are no "good" facilities here.  Unfortunately the best that one can hope for is "average" — with most "below average."  It is tragic that our area does not have "above average" facilities available. We should be outraged. Our tax payer money is going to these facilities. instead of providing quality care and adequate staffing, the facilities send the money to "management" companies that are owned by the same people who own the nursing home and don’t actually provide any services.

Our community needs to make it less profitable for nursing homes to neglect our elderly. A society is ultimately judged by how it treats its most vulnerable members. At this time civil actions are the only effective solution. The state won’t do it.