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Nursing home care: Interview with Larry Minnix

Minnix talks about nursing homes.

Nursing home care: Interview with Thomas Hamilton

Hamilton talks about nursing home care.

WASHINGTON — A statistical analysis of the federal government’s first-ever ratings of nearly 16,000 nursing homes reveals an uneven level of quality across the nation and shows how complicated it is to find a good nursing home.

The Scripps Howard analysis of the Centers for Medicare and Medicaid Services’ Nursing Home Compare system shows that:

■ Institutions run by for-profit corporations, which account for about two-thirds of all nursing facilities, generally get lower scores than those run by nonprofits.

■ Homes with more nursing staff per patient, which also tend to be run by nonprofits, generally do better in the ratings.

■ Homes with more than 100 beds tend to get lower scores in all categories, including health of residents and levels of nursing care.

■ Ratings are lowest in Southern states, particularly for nursing care and registered-nurse staffing, and highest for homes located in the Northeast.

■ Slightly more than 20 percent of nursing homes nationwide have been regularly given the lowest ratings, and 12 percent to 13 percent have received the top rating.

While more than 500,000 Americans die in nursing homes each year, more than 2 million return home after a nursing-home stay of less than three months.

The bad news for families trying to find a good nursing home for a loved one is that behind the ratings — from one star to five stars — are many complicated issues that make it difficult to assess which institutions offer the best care.

“Everyone wants to have an easy way to look up homes,” said Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, which represents more than 5,000 mostly nonprofit nursing homes and other long-term-care providers. “The concept is a good idea. But they’re not really measuring the most meaningful things, like patient- and staff-satisfaction surveys, nor do the stars take into account the patient caseload.”

He added: “One of our member homes specializes in caring for patients with pressure ulcers (bedsores). So they have a lot of patients with that condition coming in from other places and this pushes their quality ratings down. But if your mother has pressure ulcers, she may be better off in that two-star facility than in a four-star.”

Thomas Hamilton said they “offer families the first objective information on nursing-home-quality measures with meaningful distinctions between all nursing homes across the U.S.’’

Hamilton, director of the survey and certification group at the Centers for Medicare and Medicaid Services (CMS), led the design of the new rating system and continues to oversee it.

“Our hope is that families will use the system to look at nursing homes near where they live and compare quality ratings within their state. But they should consider it only a starting point,’’ Hamilton said.

“Once they pare down the list, they should print out the information and take it with them when they visit facilities and talk with residents and their families and other people who might be familiar with the home.”

CMS collects data on all nursing homes that care for Medicare or Medicaid patients and displays the information at www.medicare.gov/NHCompare. The system, implemented late last year, includes everything from fire safety and food preparation to rates of residents suffering from bedsores.

The rating system is on a scale from one star to five stars. Five stars indicate that a nursing home ranks “much above average”; four stars are “above average”; three are “about average”; two are “below average” and one is “much below average.”

Rankings are updated every three months, and some data are revamped monthly.

There are about 15,700 nursing facilities listed on Nursing Home Compare.

The ratings don’t cover facilities that accept only privately insured patients or those that, for instance, only care for people who already reside in an affiliated assisted-living complex. Nor do they rate group homes or “personal care” homes that don’t provide skilled nursing services.

There are doubts among nursing-home operators and quality advocates alike that the rating system really tells which facilities are doing a good or poor job caring for patients.

Even CMS officials agree that while the same criteria are used for the inspections, the focus and depth of the assessments may be different from state to state, so the ratings of different facilities should not be compared across state lines.

Health-care advocates say data on nursing-staff levels — self-reported by home administrators and including time spent on administrative chores as well as actual patient care — don’t give a clear picture of the care being provided. And excluding caregivers like physical therapists and advanced nurse practitioners particularly work against homes that specialize in short-term, rehabilitative care.

“The survey system does not measure quality — it measures compliance with state and federal regulations,’’ said Bruce Yarwood, president of the American Health Care Association, which represents about 11,000 nursing facilities. “We believe how a resident and family members judge the actual care provided in a particular facility is a superior indicator of quality of care.”

CMS officials say they are looking for ways to add patient-satisfaction ratings and more comprehensive staffing information to the site.

Although CMS says there are some 50,000 visits to the nursing-home Web site each day, many consumers are unfamiliar with the system.

“I’ve had families tell me, ‘We’d like to get mom into a five-star home, but we can only afford a one-star,’’’ Minnix said. “Of course, the ratings don’t have anything to do with the cost.”

A Scripps-Ohio University national telephone survey done in September and October found that 33 percent of those polled said they think most nursing homes provide excellent or good care. Of those who had actually placed a family member in a home, 35 percent felt that way.

Just under half the adults responding have experience with a close family member living in a nursing home; only 15 percent said they were aware of the ratings system.

Still, the CMS reports remain the best available resource for families to start looking for nursing-home care, said Janet Wells, policy director for NCCNHR (formerly the National Citizens’ Coalition for Nursing Home Reform), a nonprofit organization based in Washington that represents consumers of long-term care.

“Even though we’re skeptical about some of the information, it’s the best starting point available for research,’’ she said. “But people need to understand that the stars may not reflect what they’ll find inside a facility.

“Unfortunately, for many families, they’re lucky if they get 24 or 48 hours before a (hospital) discharge to make a decision. That’s not enough time to do much homework, but at least the ratings and the other information on the site might help you rule some facilities out.”

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Editor’s note: First of a two-day series. Coming Sunday to naplesnews.com: How good is the care at Naples-area nursing homes?

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