By Starrla Cray
DELANO, MN Deceiving. Irrelevant. Inequitable. Oversimplified. Confusing. Those are the words area nursing home officials are using to describe the five-star nursing home rating system released Dec. 18 by the Centers for Medicare and Medicaid Services (CMS).
“People in our industry don’t like this rating system,” Ernie Gershone, Delano Golden Living Center executive director, said. “There are too many holes.”
The star rating gives nursing homes a low of one star to a high of five stars based on health inspection results, quality measures, and staffing levels. An overall rating is also provided.
“If a facility gets a lower rating, you have to look a little beyond the numbers,” Gershone said.
To view ratings and compare nursing homes in Minnesota, consumers can go to www.medicare.gov and click on “compare nursing homes in your area.” From there, people can search for homes within a specified distance by name, zip code, city, state, or county.
“It’s just a snapshot of what’s happening that particular day,” Ann Dirks, administrator at Park View Care Center in Buffalo, said. “We got five stars, and I still don’t think it’s a fair system.”
Burns Manor in Hutchinson was given an overall rating of one star.
“Initially, I was very saddened by it,” Administrator Linda Krentz said. “But you can’t put all your heart and soul into one rating system. We have a lot of happy families, and a lot of happy residents here. I don’t know that it’s an accurate assessment.”
While she takes these ratings seriously, Krentz also looks at many other factors when determining quality.
“The ratings are part of a picture of quality, but not all of it,” Krentz said. “Our state surveys are very good, and we have a high retention of staff. That’s a quality indicator to me.”
“We have fantastic homes in this area,” Dirks said. “When people look at these ratings, they get a skewed picture.”
Facilities with low ratings still meet Federal health and safety requirements, and the ratings are not a substitute for visiting a nursing home in person, CMS stated.
“I think the main thing is to visit,” Lisa Beecher, director of nursing at Good Samaritan Society in Waconia, agreed. “Not necessarily during main hours, but nighttime and weekends to get a better feel. Look at the residents. Do they look clean? Do they look happy?”
Golden Living Center received three stars, a mark that means “average,” but Liz Fautsch of Delano, who has loved ones living at the facility, said she is impressed with the quality of care.
“I’ve come to appreciate the staff,” she said. “I can’t speak highly enough about the staff. They are so dedicated and take such good care of the residents.”
“I think ratings are difficult because there are so many things to look at,” Pam Gould, director of nursing at Glencoe Regional Health Services added.
For the quality measures portion, several factors are measured, such as percent of residents given influenza vaccinations, percent of those experiencing pain, and other resident-based measurements.
Depending on the type of residents a care center admits, the ratings might be affected, Krentz said. For example, Burns Manor is equipped with psychiatric care to help people who have behavioral dementia. As a result, the percentage of patients taking psychotropic medications may be higher than average, which could lower their score.
“Each nursing home admits different kinds of people,” Gershone said. “We take a lot of the people other nursing homes don’t take.”
The rating system tries to account for variations in care, but because there are many dimensions to nursing home quality, CMS reports stress that the ratings are to be used “only as a starting point.”
“It’s impossible to come up with a system that’s fair to everybody,” Gershone said.
To determine the health inspection rating, CMS used the three most recent standard health inspections in addition to all complaint health inspections conducted in the past three years.
“It’s a subjective process,” Gershone said. “Just because you get a few deficiencies doesn’t mean you’re a bad place.”
In addition, Minnesota’s inspectors are often stricter than other states, Beecher said.
“Our surveyors are a little tougher,” she said. “But I think Minnesota homes are actually better.”
The third dimension, staffing, can also be misleading.
“It can look a little uneven,” Jim DuChene, Good Sam administrator in Waconia, said. If a place has students working there, they might have higher turnover and thus, a lower rating, he said. “I think people need to look at more detail.”
“Visit unannounced,” Dirks advised. “You can get an immediate impression. Look for laughter and smiles. A home with one star might be the perfect place for your resident.”
In the Dec. 18 postings, about 23 percent of homes across the United States were rated as one-star, 42 percent were at two or three stars, and 35 percent received four or five stars.
In addition to five-star ratings, CMS has other resources to help people choose a nursing home, including a guide that is available on their web site, at www.medicare.gov. A print copy is available by calling 1-800-medicare.
How to find a good nursing home
By Dassel Lakeside Administrator Bill Ward
• Make a personal visit and observe. Are residents clean and well groomed? Are residents dressed appropriately for the time of day?
• Speak with family members of other residents. Do they endorse the facility?
• Check for odors that don’t go away. Some odors happen everywhere, but does the area freshen up in a few minutes or is the whole building permeated with odor?
• Is the physical environment neat and attractive?
• Watch interactions between staff and residents. Is it positive?
• Check out the activity calendar. Is there a variety of things happening?
• Ask your physician. They know where the best care is given.
• Ask your pastor. The pastors visit all the homes. They know the good ones.
• Ask staff what the facility’s family and resident survey data says about customer satisfaction.
Does not define good quality
• State Health Department survey reports
• Staffing ratio reports
• State or federal five-star ratings