Choosing a nursing home: Rating systems, inspection reports may help guide search
09/19/2013 12:00 AM
08/08/2014 10:18 AM
With Kansas nursing homes having more red marks than the national average, the decision on where to spend your twilight years – or finding a place for a loved one – is crucial.
“Every consumer needs to arm themselves with a lot of information,” said Mitzi McFatrich, executive director of Kansas Advocates for Better Care, a nonprofit advocacy group based in Lawrence since 1975.
“It’s a big decision to make, and oftentimes people are forced into making it quickly, with a loved one being discharged from a hospital and who needs to be admitted to a nursing home or assisted living. I get frantic phone calls all of the time. ‘How do I find someplace?’ We can give them information on what’s geographically close, but the second thing to look at is the inspections.”
According to Medicare’s Nursing Home Compare website, which was first launched in 1998, Kansas nursing homes have an average of 9.2 health deficiencies, while the national average is 6.8.
Inspections are conducted by the state and the information is sent to Medicare. The state also posts inspection information on its website.
In 2008, the Nursing Home Compare website added a five-star rating system and continues to add more detailed information and inspection reports so that consumers can see specific issues. The site allows consumers to pick and compare up to three nursing homes at a time.
But no such rating system is perfect, said Matthew Bogner, CEO of Kansas Masonic Home, which is rated four out of five stars.
“My biggest bone to pick with the system is that it purely focuses on clinical care and not resident choice and autonomy,” Bogner said.
“It doesn’t take into account culture change and the move from the institutional 1960s model to one where residents have basic rights and choices. Some traditional nursing home residents still don’t have much choice when they wake up, when they go to bed, when they eat, what they eat.”
Nothing replaces an in-person visit, said Joe Ewert, commissioner of survey, certification and credentialing for the Kansas Department of Aging and Disability Services.
“No amount of information that is found in writing will substitute for a visit in person to a facility,” Ewert said. “Family members need to look for themselves and speak to other residents and family members for the best source on the quality of care and life in the nursing home.”
More than 18,000 Kansans live in nearly 350 nursing homes across the state. Of all the nursing homes in Kansas, only about 10 are not certified to participate in Medicaid and Medicare, Ewert said.
As the population ages, and health care allows people to live longer, nursing homes face new challenges, Ewert said.
“From a regulatory standpoint, nursing homes of today have typically older, more frail residents than they did 15 years ago,” Ewert said.
“There are more opportunities for support and services in the home, which delays entry into nursing homes. … The nursing homes are dealing with ever increasing need.”
By law, nursing homes are required to have an inspection once every 12 to 15 months. If the state goes beyond that time frame, it can face federal penalties, Ewert said.
Typical yearly inspections usually require about 200 hours of on-site time, Ewert said, and the inspections are done by registered nurses. Facilities are required to provide their inspection results in a notebook to guests upon request.
Inspections often are the only objective look any nursing home ever gets of itself, McFatrich said.
When looking at inspection reports, people should look for anything that is rated “G” level of deficiency or higher, McFatrich said.
“The G level and above indicates actual harm to immediate jeopardy or mistreatment of an adult,” she said. “You need to take a hard look at those facilities.”
In Kansas, about a quarter of facilities have had a least one deficiency of that level every year, McFatrich said.
While looking at inspections over several years can help a person see trends, Bogner said he’s wary of looking at one inspection and basing a decision on that because results can be skewed year to year based on the stringency of an individual inspector.
Among the more common deficiencies identified in Kansas nursing homes are care plans that are either not in place or not followed by nursing homes, Ewert said.
“In essence, if Joe has been losing weight and he is sleeping more than usual and had a couple of falls in the past, they would need to put interventions in place, a care plan document – that hold that all in place,” Ewert said. “They have to measure whether they achieved those outcomes.”
Issues that are most common in such care plans include weight loss of residents, falls and pressure sores, Ewert said.
If people have a complaint, they can call the state hotline at 800-842-0078. The hotline is used to help the state perform special investigations.
Nursing homes are given time to correct issues. Over time, if issues aren’t corrected, they can face penalties, including penalties on admissions.
“That doesn’t allow them to take new admissions or get paid (from Medicare) until they are compliant,” Ewert said.
Nursing home staffing
One of the biggest indicators for the quality of a nursing home is the time staff spends with residents, Bogner said.
“Staffing is one I think is most black and white since the most concrete research shows higher staffing associated with higher quality care,” he said.
McFatrich said consumers should check to see the nurse-to-resident ratio for the facility for all shifts, especially the night shift.
“It’s not uncommon in our state for one aide to have 14 people to take care of, which is not enough care and help for individuals,” she said.
“If you don’t have enough care to help you go to the bathroom, you may soil yourself, which can lead to unnecessary infections. Those are really critical and important issues for health independence and dignity.”
Kansas Advocates for Better Care maintains a database of every licensed care home in the state, McFatrich said, and it tracks consumer complaints. Though the database is not yet available online for public access, people can call the organization to request information about particular nursing homes.
The best thing families can do is to plan ahead, Ewert said.
“Typically, long-term care is not discussed by family members, parents, grandparents, until it’s a crisis situation, so the best thing they can do for themselves and loved ones is to have these conversations,” he said. “The information is out there, it’s just key for folks to discuss it before they need to find their next step.”
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