Most people have heard of five-star ratings for restaurants and hotels. But nursing homes?
That's how the federal government's new, Zagat-like rating system for nursing homes will work. Released earlier this month by the Centers for Medicare and Medicaid Services, the new system ranks nearly 16,000 nursing homes across the country, all of which participate in either Medicare or Medicaid. Each nursing home was given between one and five stars based on the results of health inspection surveys, staffing information and various quality of care measures.
But the system, intended to be a ''straight-forward assessment of nursing home quality,'' has drawn the ire of some in the industry who say it isn't comprehensive enough to really work for such a complicated niche of the health care industry and doesn't provide enough detail.
''We are simply not in the restaurant business,'' said Karl Sisson, the director of development for Heritage Ministries, a nonprofit Christian organization that provides human service ministries to more than 600 people in Chautauqua County. ''The nursing home industry is very complicated and reducing a rating system down to a number of stars isn't going to help the public better understand what a nursing home is, much less choose one for their family member.''
HOW IT WORKS
The new ranking system is available by going to www.medicare.gov, scrolling down and clicking on the ''New Nursing Home Five-Star Quality Rating'' link.
From there, users can click a link taking them to the Nursing Home Compare Web site, where they can search nursing home ratings by facility name, city, county, state or specific ZIP code.
Conducting a search for nursing homes within 50 miles of the 14701 ZIP code, for example, will pull up a list of 24 nursing homes. Users can choose up to three and compare their statistics side-by-side. Users can also review a more in-depth list of statistics on each individual nursing home by simply clicking on its name.
The new rating system provides star ratings for nursing homes in three categories - health inspections, staffing and quality measures. Then, those star ratings are combined to calculate an overall rating.
The number of so-called ''health deficiencies'' for a particular nursing home are taken from reports each home is required to file. If a nursing home has any such deficiencies, they are listed on the report for that home, along with the inspection date, the date the deficiency was corrected and the severity of that deficiency.
Also part of the new ranking system is information regarding staffing at a particular nursing home. The ranking system counts the number of registered nurses, the number of residents, the number of licensed nurse staff hours per resident per day and the number of certified nursing assistant hours per resident per day. Those numbers are compared with state and national averages.
Finally, the new ranking system lists a number of so-called ''quality measures'' that include categories such as the ''percentage of high-risk, long-stay residents who have pressure sores'' or who are ''more depressed or anxious.'' The percentages a particular nursing home has in each category are compared with state and national averages.
''Our goal was to provide families with a straight-forward assessment of nursing home quality, with meaningful distinctions between high- and low-performing homes,'' said Kerry Weems, the acting administrator for the Centers for Medicare and Medicaid Services. ''Because quality and conditions within a nursing home can change at any time, this system is not intended to be the only tool families use in selecting the right nursing facility.''
According to the Centers for Medicare and Medicaid Services, only about 12 percent of the nursing homes rated nationwide received a full five-star rating, while 22 percent received a one-star rating. The remaining 66 percent were evenly distributed between two-, three- and four-star ratings.
There are 327 nursing homes that accept Medicaid and Medicare in the Upstate New York region, which doesn't include New York City or the surrounding area. In that area, there are 324 nursing homes. Just 32 upstate New York nursing homes earned a full five-star rating, while 82 received a one-star rating. Seventy-five others received a four-star rating, 72 were given a three-star rating, and 66 earned a two-star rating.
Three nursing homes in the Jamestown area - Heritage Park on Prather Avenue, Heritage Green in Greenhurst, and Lutheran Retirement Home on Falconer Street - appear on the new ranking system. Heritage Park was given an overall rating of four stars, while Heritage Green and Lutheran Retirement Home each received a two-star rating.
NO SUBSTITUTE FOR A VISIT
Both the American Association of Homes and Services for the Aging, or AAHSA, and the New York Association of Homes and Services for the Aging, or NYAHSA, issued statements regarding the new ranking system.
''The rating system is a great idea prematurely implemented,'' the AAHSA said. ''We support a consumer-friendly nursing home rating system based on reliable quality information the public can understand. But (this) is poorly planned, prematurely implemented and ham-handedly rolled out.''
The AAHSA went on to say the new rating system needs a great deal of improvement, chiefly the immediate development of a data collection tool for staffing information. The survey and certification system should be overhauled, according to the AAHSA, and funding should be provided for a new system.
''There is absolutely no substitute for visiting the nursing home yourself and using your five senses to form your own impression,'' the NYASHA said in its statement. ''The staffing component (of the new rating system) is a snapshot and requires much immediate work. Inspection data is inconsistent.''
Sisson agreed with the AAHSA and the NYAHSA.
''One of the rankings given is the percentage of high-risk, long-stay residents who have pressure sores,'' Sisson said. ''Nursing homes actually admit people who already have pressure sores. But because these patients are in your facility with pressure sores, it gets you a lower rating. It doesn't matter that you've treated the wound and are taking steps to provide continuous care. It doesn't matter whether or not the patient developed the sore while actually at the nursing home. You're just given a percentage and that's the only information made available to the consumer through this new ranking system.''
The new ranking system has other deficiencies, Sisson said. He pointed out that the ranking system gives users only a vague idea of a nursing home's patient population, which skews the results and the user's perception of the home.
''It's not an apples-to-apples comparison,'' he said. ''If there are many patients in your facility who suffer from dementia versus patients who are there primarily for rehabilitation purposes, the number of hours you spend per patient is going to be dramatically different. But there's no way to see that on the report - and some nursing homes come out looking like they don't spend time with their patients.''
The new ranking system ''doesn't put anyone in a good light,'' Sisson said. He said the ranking system only ''reinforces the negative stigma'' that the nursing home industry faces.
''The system is a great idea, but by coming out with it like this, the Centers for Medicare and Medicaid Services made nursing homes look bad,'' he said. ''But nursing homes have changed dramatically in recent years. A nursing home is no longer just this place that you go and slowly decline. It's much more of a short-term focus. We've got more younger folks using our facilities now than ever before because most nursing homes have excellent rehabilitation facilities. We can provide very specialized service. Things that used to happen in hospitals now happen in nursing homes. It's pretty comprehensive. Things are drastically different.''
Charles Rice, the vice president of health care services at Lutheran Retirement Home, said he felt the report is ''very subjective.''
''Data isn't necessarily information, and it's important that people keep that in mind,'' he said. ''The ranking system is based on self-reported information and some of the questions are subjective. There's no uniformity.''
In order to work properly for the nursing home industry, Rice said any such ranking system would have to be ''much more comprehensive.''
''Nursing home care is far too complicated to be reduced down to a one- to five-star rating,'' he said. ''It just doesn't work well. In an attempt to simplify the process of searching for a nursing home, the Centers for Medicare and Medicaid Services offered skewed information. Their system doesn't measure quality, it measures deviation from a standard. So the phrase 'quality indicator' is really a misnomer.''
Rice said while the ranking system is ''a good idea,'' it should be no substitute for a personal visit to any nursing home.
''The best thing you can do is not rely solely on ranking systems,'' he said. ''Visit the home. Ask a lot of questions. Pay attention. Take notes. See it first hand and use your best judgement to make a decision.''
