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

U.S. News & World Report issues the best and worst nursing homes every year based on federal and state inspections, surveys, and required data on staffing.  Here is the most recent article.  The rankings are only as good as the investigators which in most cases is poor.  On a given day, 1.5 million people are living in the nation's 16,000-plus nursing homes, and in a typical year more than 3.2 million Americans will spend at least some time in one. 

The U.S. News rankings rely on Nursing Home Compare, a program run by the federal Centers for Medicare and Medicaid Services. CMS analyzes information on all homes enrolled in Medicare or Medicaid.  The homes also receive ratings of one to five stars in each of three areas: health inspections, nurse staffing, and measures of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code. But you can't assume that all five-star homes, or those with three or four stars, are of the same quality. There are so many homes in each rating—1,855 in the five-star and 3,661 in the four-star categories alone—that the range of performance is bound to be very wide. Nor can search terms be combined if, say, you want only five-star homes within 50 miles of a specific city.

America's Best Nursing Homes addresses these and other issues. Homes are presented in tiers within each star category, based on their total stars in all three of the major areas. The topmost tier, for example, consists only of five-star homes that got 15 stars. The next tier down is five-star homes with 14 total stars, and so on.

Here are more details about the measures that go into the CMS ratings.

Health inspections. Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. They also investigate health-related complaints from residents, their families, and other members of the public. "Health" is broadly defined, as is evident in the 180-some items on the checklist. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents' rights and quality of life, and proper skin care. A home's rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings do not factor into the CMS ratings.

Nurse staffing. Even the best nursing care is not enough if there are too few nurses to spend much time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. 

Quality measures. Nursing homes have to furnish the latest three quarters of clinical data showing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. The Best Nursing Homes rankings and Nursing Home Compare display data for each home on all 19. The ratings, however, are based on 10 that are considered the most valid and reliable, such as the two above and measures related to pain, bedsores, and mobility.

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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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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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