Nursing homes get poor ratings

Published 11:12 am Friday, December 19, 2008

According to a new rating system aimed at improving the quality of care for residents in nursing homes, Lawrence County’s facilities need improvement.

Some in the health care industry are questioning the mechanics of the federal ratings system and its overall validity while others say it will lead to improvement for people who must rely on nursing homes for their own care or that of loved ones.

The ratings system, developed by the Centers for Medicare and Medicaid Services, is based on state inspections, staffing levels and quality measures, such as the percentage of residents with pressure sores.

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Each nursing home can receive up to five stars for each of those categories as well as up to five stars for their overall quality.

Three of Lawrence County’s facilities, Heartland of Riverview and River’s Bend Health Care, both in South Point, got 2 stars out of a possible 5, as did Jo-Lin Health Center in Ironton. Sunset Nursing Center in Coal Grove and Bryant Health Care Center in Ironton each got 1 of 5 stars.

David Dixon, administrator of Sunset, said the new system is “not fair and very flawed,” a sentiment echoed by Peter Van Runkle, executive director of the Ohio Health Care Association.

Dixon said the surveys were subjective and the survey teams were not consistent in what they looked for and how they judged the facilities. He also said the ratings were often based on outdated information.

“The system is frustrating. It does not represent what care we provide at this facility,” Dixon said.

Mark Stewart, administrator of Heartland of Riverview, referred inquiries to Julie Beckert, spokeswoman for HCR ManorCare, the national entity that owns his facility. In a prepared statement, Beckert said the system did not recognize that the difference between facilities such as HCR ManorCare, that provide a very high level of comprehensive medical and intensive rehabilitation, and those facilities that provide a less complex level of care or who operate more as residential caretakers.

“This system does not reflect innovation in facilities such as how well pressure ulcers are healed, whether centers provide pressure ulcer prevention services or how well a center works to reduce pain,” Beckert said. “There is no measure for what rehabilitation programs and services are offered to patients which is the reason the majority of our patients come to HCR ManorCare facilities.”

Van Runkle said he is also “extremely concerned” about the new federal ratings system and compared it unfavorably with the ratings system conducted regularly by the Ohio Department of Aging. He said the way in which the federal report used the information it obtained was flawed and said the 5-star system “was a simple rating for a complex issue.”

Van Runkle said one of the problems he has with the federal rating system is the opinions of consumers— people who use these facilities — were not included in the rating system.

He also said the people who conducted the federal report automatically decided that a certain percentage of the nursing homes in each state would be given only one star and only a certain percentage would be allowed five stars regardless of how many were actually similar in quality.

“A lot of good facilities got one star and strangely, some that were not so good ended up getting higher ratings,” Van Runkle said.

He suggested the whole thing be discontinued until changes can be made that will better reflect the actual quality of care at these facilities.

But federal officials say the rankings will put nursing homes ‘‘on the path to improvement’’ because they know family members will think twice before putting someone in a one-star home.

Consumer groups like the concept, but they 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 issued a press release warning that nursing homes may appear in the ratings to give better care than they actually do.

‘‘Our initial reaction is that consumers should probably avoid any facility with a one- or two-star rating and even a three-star rating unless people they trust convince them that the rating is inaccurate or unfair,’’ she said.

The Associated Press contributed information to this story.