Nursing Home Abuse

Raising the Bar for Nursing Home Ratings

In late February of this year, federal star ratings of almost one-third of the nursing homes in the U.S. took a big hit. This is the result of a major adjustment of the quality standards that the Centers for Medicare and Medicaid Services references.  The goal is to make these ratings more meaningful to those considering long-term care facilities for themselves or for their elderly parents.

The main changes that went live on February 20, 2015 include adjusting the curve for the quality-measures (QM) rating. This rating is based on information about each patient. Here’s what Medicare states on its Nursing Home Compare website.

We have made 3 significant improvements to the Five Star Nursing Home Quality Rating System:

  1. Incorporated the 2 nursing home quality measures for antipsychotic use into the Quality Measure Rating.
  2. Increased the number of points necessary to earn a Quality Measure Star Rating of 2 or more stars.
  3. Changed the scoring method for the Staffing star rating. Nursing homes must earn a 4-star rating on either the RN or total Staffing rating to achieve an overall Staffing rating of 4-stars.

A large number of nursing homes are impacted by this new rating system and will see lower quality measure rating as a result of these changes.

Last fall, The New York Times published a scathing report about the nursing home rating system. The problem was that it relied too much on unverified information that even homes with a documented history of quality problems were earning top ratings. Nursing homes reported on two of the three major criteria used to rate operations — staffing levels and quality measures statistics — which were not audited by the federal government.

Last October, the federal government announced that it begin its requirement for nursing homes to report their staffing levels quarterly viaan electronic system. The new electronic system can verify the reports with payroll data. Moreover, a nationwide auditing program focused on the accuracy of a home’s quality statistic commenced at the same time.

As the New York Times points out: “Before the [Feb. 20, 2015] change, about 80% of the nation’s nursing homes received a four- or five-star rating out of five on their quality measures score; afterward, nearly half did. The number of homes receiving one star in that area increased to 13 percent, from 8.5 percent, after the recalibration.”

Consumer advocates on behalf of elder care applaud this stricter measure. Consumer Voice public policy director, Robyn Grant, told the NYT: “We think that rescaling the quality measures will result in improved reporting of the quality of care a nursing home may provide.” I can’t help but agree.

CNAs attempt to get minimum staffing levels mandated

When reading one of my favorite sites for local updates, the Public News Service, I was reminded about the sad state of affairs for Washington caregivers in the nursing home industry. Washington doesn’t have a state law that spells out minimum staffing levels in nursing homes.  In the 2015 legislative session, nursing home caregivers will continue their battle to implement some basic staffing minimums.

Nursing/healthcare workers union members lobby for minimum staffing standards later this month.

Nursing/healthcare workers union members lobby for minimum staffing standards later this month.

Nursing home workers cite three reasons to mandate minimum staff-to-resident ratios: 1) Better care for nursing home residents, 2) Less turnover for weary staff members, and 3) Greater safety for both groups.

Shelly Hughes has been a Certified Nursing Assistant (CNA) in Washington facilities for five years. She explained that rarely is there enough time or enough staff in place to give residents the care they need. “One of the most heartbreaking things about my job is that I see great, kindhearted, hard-working people leaving,” she says. “Not only my facility, but the industry entirely because they’re so frustrated with the level of care we’re able to give our residents.”

Ms. Hughes says under current conditions, a CNA could be on duty for 15 or 20 residents.  Can you imagine? That ratio is not at all conducive to quality care for nursing home patients. However, Hughes points out that the facilities know in advance when state surveyors are coming to inspect. This is when managers pitch in and there are plenty of people scheduled.

AARP research indicates an annual turnover rate of 52% among nursing home workers in the state. Hughes says SEIU’s proposal would implement staffing rules over a three-year period, and nursing homes would submit monthly staffing reports with payroll records to the state, to confirm that they’re in compliance. She and other caregivers with SEIU Local 775 have been sharing their stories with Washington lawmakers, and she believes a new state law is a matter of time. “It will take a while, but I haven’t met a legislator yet that disagrees with anything I have to say,” says Hughes. “I think the will is there, we just have to find a way.” She adds, Oregon and California both have direct-care staff requirements for nursing homes. Washington caregivers will make their case at a lobby day in Olympia later this month, January 29.  

Take a peek at the local nurses union and their inspirational message to its members at its website.

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