South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

USA Today had a great article on the excessive number of nursing homes that receive taxpayer money but refuse to meet the minimum requirements for quality of care.  The requirements are basic and necessary services, and fundamental safety and food standards. Personal hygiene, responding to call bells, fresh foods, hot water, taking vital signs, etc----basic stuff but because of greed and short-staffing one in five of the nation's 15,700 nursing homes have consistently received poor ratings for overall quality.

More than a quarter-million patients live in homes given another set of low scores within the past year, according to data released today by Medicare, which first released the star ratings of the nation's nursing homes in late 2008. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009.

USA TODAY found that all 50 states and the District of Columbia have homes with poor ratings from one year to the next.  And dozens of those facilities are the only nursing homes for miles.

Late in the Bush administration, the Centers for Medicare & Medicaid Services began assigning nursing homes one to five stars for quality, staffing and health inspections, as well as an overall score. Nearly all homes that repeatedly received few overall stars — one or two stars — were owned by for-profit corporations, the data show.

"The issue is the owners have to take responsibility for the consequences" of poorly performing homes, says Larry Minnix, CEO of American Association of Homes and Services for the Aging.

The newspaper's analysis found the lowest-rated homes had an average of 14 deficiencies per facility, which can include quality-of-life measures and safety violations.

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Anderson Independent Mail posted an article by Lee Bowman and Thomas Hargrove/Scripps Howard News Service about a statistical analysis of the federal government’s first-ever ratings of nearly 16,000 nursing homes.  The study revealed some comon sense conclusions including 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:

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

Homes with more nursing staff per patient, which also tend to be run by nonprofit groups, 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 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.

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.  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.

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.

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.

“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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WCCO out of Minnesota had an article about how most violations in nursing homes are under reported.  This seems like common sense since most employees do not want to risk their jobs admitting mistakes, and there is not enough personnel to enforce the regulations or conduct proper investigations. Many complaints are ignored because the nursing home claims the resident was demented.

The system designed to help Minnesotans choose a nursing home for loved ones is under fire. Serious flaws in the system have been uncovered by a nursing home watchdog group.  You might not know about physical and sexual abuse happening inside the nursing home.

Wes Bledsoe, the founder of a nursing home watchdog group, says he can prove that the rating system on Medicare.gov does not show what is really going on in nursing homes.  For example, after all of the well known abuse at Good Samaritan Society in Albert Lea, a report from the Minnesota Department of Health says no deficiencies were noted at the nursing home.

At a different facility in the state, someone saw an employee pick up a nightgown soaked with urine and that worker "shoved it in the resident's mouth and told her to shut up." Again, the Department of Health didn't note any deficiencies.

A spokesperson from the Minnesota Department of Health said "If a facility has taken appropriate steps to correct problems, they may not be cited with deficiencies."  However, when deficiencies aren't noted, they don't show up on the Medicare site, so there's no way you could know if you've only checked that Web site.

Bledsoe said it's happening all the time. He found that 80 percent of confirmed abuse cases in Minnesota in the last four years didn't get reported to the feds.

"I think it's bureaucratic mumbo-jumbo that's deceiving the consumers and the American public about what's really going on in our long-term care facilities," said Bledsoe.

Bledsoe said another big problem is the star system on the Medicare Web site. On a lot of the nursing home Web sites, a lot of the information is not available, so he's wondering how they can give a place four or five stars when there's no information.

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The Chicago Tribune had a well written and tragic story on the living conditions in a one star nursing home.  The articles discusses numerous and disgusting incidents of neglect that injured residents both physically and psychologically.

Dozens of health violations were documented last year on a single inspection of the Berwyn Rehabilitation Center, contributing to its dubious distinction as one of the area's worst nursing homes in the area.   The federal government is now rating nursing facilities on a 1 to 5 star system. Although conditions at one-star homes are startling, what is perhaps more alarming is their prevalence: About a quarter of U.S. nursing homes, including 81 in the six-county Chicago area, received one star.

The Tribune obtained the most recent inspection reports for the area's lowest-rated homes through a Freedom of Information Act request. The conditions described are grim and, at times, deadly—as the Berwyn facility demonstrates.

Inspectors found workers were improperly using side railings on beds. Four months later, records show, a 53-year-old obese resident suffocated when he got stuck between the mattress and side rails. Illinois fined the facility only $50,000 for the death, one of the largest nursing home penalties in the state last year.

According to records, all major violations found during the annual inspection last March had been corrected as of June. But the man who suffocated did so in July—weeks after new management took over. 

One-star nursing homes meet minimum standards but are considered "much below average," according to the federal rating system. Inspection reports of those facilities show the daily despair many residents face.

Residents in most nursing homes complain of cold or tasteless food, staff not answering calls for help, loud employees keeping them up at night, and workers not relaying phone messages from family members.

Residents say that when they voice concerns, staff respond at times by pointing to the cemetery across the street. State investigators cited the nursing home, concluding that residents could not speak up without fear of reprisal.  Almost all the patients lay in their beds, sleeping or watching TV.  The vast majority of the residents can't walk and are incontinent.  

This is a great article for anyone who wants to know about the care provided in many nursing homes throughout this country using our tax money.

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We have many people call us asking for advice on how to choose a nursing home. Many of the people seeking advice want to rely on Medicare's star ratings.  We are not convinced that these star ratings give an accurate assessment of a nursing home's ability to provide good care.  The ratings are primarily based on surveys and investigations done by the Department of Health and Environmental Control (DHEC).  Well, the problem with that is DHEC tells the facilities when they are going to investigate or conduct a survey giving the facilities time to get their best nurses in the facility, to staff more than typical, and make sure all the documentation is revisited and changed if lacking.  

When abuse or neglect is reported, the state's investigations procedurally favor the facilities. Violations must be actually found in the facilities' own documentation, which are very self-serving. We cannot rely on the state for enforcement of regulations that are designed to protect residents and ensure proper care.

The key to quality of care is competent, compassionate, and well-trained staff.  They are less likely to get burnt-out and more likely to stay in the job thus lowering turnover rates which are detrimental to residents especially those with dementia.  The reality often is that staff who complain about resident neglect don't remain employed.  Fortunately there are laws to protect workers from retaliatory firing, but many employees still fear losing their jobs by speaking up.  Regulations exist to protect residents from neglect, but residents and employees fear retaliation. Many times families aren't aware neglect is occurring. Facilities lie and cover up to protect themselves from liability.

There are no "good" facilities here.  Unfortunately the best that one can hope for is "average" — with most "below average."  It is tragic that our area does not have "above average" facilities available. We should be outraged. Our tax payer money is going to these facilities. instead of providing quality care and adequate staffing, the facilities send the money to "management" companies that are owned by the same people who own the nursing home and don't actually provide any services.

Our community needs to make it less profitable for nursing homes to neglect our elderly. A society is ultimately judged by how it treats its most vulnerable members. At this time civil actions are the only effective solution. The state won't do it.
 

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The Aiken Standard had an interesting editorial about the deficient care of nursing homes in Aiken, South Carolina and the new 5 star rating system.  The editorial states that nursing homes are increasingly becoming an integral part of the health care network in our country. As people live longer, the chances that they will spend some time in a nursing facility increases. That is why the federal government's five-star grading system is so important for patients and their families.

The five-star comparison allows people to compare nursing homes in their areas and to determine which might be the best for themselves or their loved ones.

Medicare recently came out with its latest report on nursing home quality, grading all six of the nursing home facilities in Aiken County. Only one of the six scored at the five-star level which means "much above average" according to the Medicare guide. Carriage Hills Living Center scored at the five-star level.

Only one of the other five, NRC Healthcare - North Augusta, was at the three-star, or average, level.

Pepper Hill Nursing and Rehabilitation Center score two stars out of five, below average.

The other three, Anne Maria Rehab and Nursing Center of North Augusta, Azalea Woods Nursing Home in Aiken, and Heritage Healthcare at Mattie C. Hall in Aiken, all scored one star out of five, much below average.

It would be hoped that all of the local facilities would have scored at least average. Further it is hoped that patients and their families will insist that improvements be made in the future.

Complete information about the nursing home comparisons can be found online at www.medicare.gov/NHCompare.

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