New rating system gives most homes high marks

Six of the seven nursing homes in Marion County received five or four stars in the new five-star rating system unveiled Thursday by the Centers for Medicare and Medicaid Services.

Receiving the top rating of five stars were Legacy Park in Peabody, Salem Home in Hillsboro and St. Luke Living Center in Marion.

Bethesda Home in Goessel and Parkside Homes in Hillsboro each received four stars, as did the Golden Living Center in Marion, which was closed by its corporate owner last month.

Westview Manor of Peabody received two stars.

Under the new CMS system, five stars mean ?much above average,? four stars mean ?above average,? three stars mean ?average,? two stars mean ?below average? and one star means ?much below average.?

Mixed reviews

The new rating system is intended to provide straightforward assessment of nursing home quality, according to a statement on the CMS Web site by Kerry Weems, acting administrator.

But not all nursing home officials share the agency?s enthusiasm.

?This is yet another example of the federal government wasting time, energy and money on something that, bottom line, is confusing and is based on flawed information,? said Cindy Luxem, executive director at the Kansas Health Care Association, which represents the state?s for-profit nursing homes.

?Whatever time and money they spent doing this would have been better spent helping providers provide better care,? she said.

Luxem and others are upset that the data used in developing the ratings were taken from annual inspections conducted by the Kansas Department on Aging.

?National studies have shown that the information in these surveys is inconsistent, it?s flawed,? said Deborah Zehr, executive director at Kansas Association of Homes and Services for the Aging.

The association represents the interests of the state?s nonprofit homes.

?These ratings are a piece of information, but that?s all they are?a piece,? Zehr added. ?They?re not a complete picture, and they may not reflect conditions?good or bad?going on in a facility.?

The new system is based on three factors:

n Inspection survey results from the previous three years.

n A compilation of quality-of-care measures.

n Data showing the number of hours spent caring for residents.

Depending on the results, each category is assigned one to five stars, which were blended for an overall rating.

?Another tool?

KDOA officials were cautious in their assessment of the new ratings.

?We see this as another tool for consumers,? said KDOA spokeswoman Barb Conant. ?But it?s not the only tool, it?s not the only thing they should look at. It does not take the place of visiting a home, talking with residents and family members, or asking the facility to explain why it got a one-star rating.?

Conant said KDOA ?did not have much input? in designing the system. She defended the data gathered during the department?s inspections.

?All of our surveyors are nurses, they?re all RNs, they?re all well-trained,? Conant said. ?As for their being subjective, I don?t know how you?d do something like this and not be subjective to some degree,? she said.

CMS spokeswoman Mary Kahn dismissed the concerns of Zehr and Luxem.

?We have a high level of confidence in the new system,? Kahn said. ?It?s worth noting, I think, that the survey data is averaged?it?s based on three years of surveys, not one?and the quality and staffing measures are based on information that?s self-reported.?

It?s true, Kahn said, that some of the data is several months old, but it?s also the latest available.

?The other thing to remember is that this is a dynamic system,? she said. ?It?s going to be updated all the time, and there will be measures taken in response to some of the criticisms.?

Kahn, too, said the system was not intended to be the sole tool for judging nursing homes.

?If you live in a community where the only nursing home received a one-star rating, that doesn?t mean you should expect poor care,? she said. ?It means you should be vigilant, you should be talking to your (state) ombudsman, you should be talking to the home, you should be saying, ?OK, what are we going to do about this???

Administrators react

The administrator for Westview could not be reached for comment, but the five other administrators in Marion County were pleased to be highly rated by the CMS system.

?There are lots of counties in the state that don?t have any five-star-rated facilities,? said David Scott of Legacy Park. ?For us to have three in this immediate area, it generates the kind of an environment where people should be, if not comfortable with the idea of long-term-care placement, at least have a level of confidence that the quality of care their loved ones are going to receive is going to be good.?

At the same time, administrators expressed mixed feelings about the system itself.

Kelly Schlehuber at Salem Home said the CMS system is an improvement on what?s been available to this point.

?For the first time ever, I thought they used a system that was more comprehensive than just the snapshot in time when they come in for three or four days for the annual survey,? she said. ?They took into consideration the quality measures and the staffing ratios to come up with that, and I think that?s a much better measure than just your (state) survey.?

Linda Peters, administrator at Bethesda Home, said she found it hard to understand how the ratings were achieved.

?I?m really perplexed by it, to be quite frank,? she said. ?It doesn?t give a good picture of care in facilities.

?The CMS announcement is really misleading to the public in general, who are not familiar with nursing homes,? Peters added. ?It seems like you can go on this Web site and you get an accurate picture?and I think that?s just a false assumption.

?We were rated fairly high and that pleases me?and I do feel we are a quality provider,? Peters added. ?But as I looked over a number of nursing homes across the state that I?m personally familiar with, I don?t think the ratings were reflective of the care they give. ?

Gretchen Wagner at Parkside said it?s simply too early to know how accurate the CMS ratings system is.

?I do think it is a helpful tool to consumers,? Wagner said. ?But it?s important for people to evaluate the entire package all at once, and remember that (the rating system) is only one tool.?

Debbie Craig at St. Luke Living Center echoed that idea.

?The regulatory piece and the information you find on line isn?t a good enough picture of what goes on in long-term care units,? she said.

Collectively, the administrators offered a variety of additional recommendations for anyone considering a nursing-home placement:

n Use the CMS rating system as a starting point, but not the final determinant. ?If I was looking at and looking for a place to put a loved one, I think there would be some merit in that it would narrow the field down,? Schlehuber said. ?I?d pick the ones that were rated fours and fives to go visit, talk to the staff and see how the place was running.?

n Visit a home more than once. Wagner said it?s a good idea to visit the same home at different times of the day ?so they see the different aspects of the home.?

n Don?t necessarily set up a visiting time in advance. ?I always tell people to come unannounced,? Craig said. ?I think we can call and make appointments at places and things might look different than if we just show up.?

n Solicit recommendations from residents that live in the home currently, or have had a personal experience with the home. Also, speak with their family members if possible.

n Contact state organizations such as KDOA, Kansas Health Care Association, and Kansas Association of Homes and Services for the Aging.

Said Peters: ?Those people are familiar on a local level with the homes, as opposed to a mathematically generated number that?s done at a federal level.?

Dave Ranney, a writer with Kansas Health Institute New Service, contributed significantly to this article

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