MOUNT VERNON — A new system for rating nursing homes has administrators up in arms, saying the system does not accurately reflect all that goes on in their facilities.
“It’s a brand new program,” said Greg Carnes, administrator at Country Club Center II on Yauger Road. “It’s too soon to really form an evaluation. I’m surprised CMS is releasing this information — they still don’t have all of the bugs worked out.”
The rating system was developed by the Centers for Medicare and Medicaid Services. Based on a five-star rating, with five being the best, rankings are based on state inspections over the past three years, staffing levels during a specific two-week period and quality measures. Facilities are ranked in each category, as well as given an overall rating.
None of the nursing homes in Knox County received a rating of 5. The Rose Garden Nursing Home in Mount Vernon received an overall rating of 4; Country Club Center II and the Ohio Eastern Star Health Care Center received a 2; and Centerburg Pointe, Country Court, Heartland of Centerburg, The Laurels of Mount Vernon and Whispering Hills Care Center received a rating of 1.
Administrators, however, say there are a number of problems with the system.
“It’s old data, not current,” said Carnes. “Some of the data are things not required by the state of Ohio.”
Jim Griffiths of Griffiths Healthcare Group has been in the health care business for a number of years.
“I have never received a substandard citation in my entire career,” he said. “I bought Centerburg Pointe in January. They’re grading me based on the previous owner. ... The building itself is being replaced; some of those citations were because of the building.”
Griffiths said the latest survey at the 34-bed facility was good.
He also said the CMS survey was very subjective.
“I have 10 nursing homes in Ohio,” he said. “I have homes that got 5 out of 5. It’s the same owner, the same policy and procedures, the same clinical people, the same menu. How can you have a building in Marion County that gets a 5 out of 5, Wayne County gets a 5 out of 5, and the same owner gets a 1 out of 5 in Knox County?”
Centerburg Pointe and Country Club Center both received a 2-star rating in the area of staffing. Carnes and Griffiths disagreed with that rating, as both facilities meet the staffing requirements put in place by the state of Ohio.
“If you meet the state standards, it’s hard to fathom [how you can get a rating of 2],” Carnes said. “You would have to far exceed the state standards to get a 5-star.”
Carnes said it’s hard to understand how his facility, which has 75 beds, got a 2 when other facilities received a 4.
“I staff more RNs than those facilities,” he said. “It’s not accurate and makes us look bad.”
Carnes said the two-period CMS looked at is just a “snapshot in time.”
“If you improve, it isn’t reflected for a year,” he said.
Griffiths agreed it was just a “snapshot,” but went further.
“With what we are facing in this country, we need to be more efficient ...,” he said. “My buildings typically run at the required levels, but I don’t believe in just throwing people at the problem. Just because you have more staff, it doesn’t equal better care. The people we have hired, we train, we retain, we pay them better benefits, we expect more. They stay with us, it’s not a revolving door.”
That, in turn, he said, provides better care for residents.
CMS, said Griffiths, should be looking at acuity, outcomes and patient satisfaction surveys.
“Higher acuity buildings are going to score poorly,” he said.
For example, one of the areas measured by CMS is the number of patients who have pressure sores.
“If you have patients with a pressure sore, that takes away from the overall score. Patients come to [Centerburg Pointe] with pressure sores,” he said. “If you don’t have very many, you get a better score. But it’s not measured how well you’re treating the ones you do have, or if they’re getting better.”
Carnes agreed more importance should be placed on the acuity of patients, as did Julie Beckert, associate vice president of marketing for HCR ManorCare, the parent company of Heartland of Centerburg.
“CMS’s five-star quality rating system fails to differentiate between the levels of care and services provided by the 17,000-plus skilled nursing centers in the United States,” she said in a written statement. “The system does not recognize that providers such as HCR ManorCare that provide a very high level of comprehensive medical and intensive rehablitation should be rated on different criteria than centers who provide a less complex level of care or who operate more as residential caretakers.”
In addition, she said, the rating does not measure the programs and services that go above and beyond basic care.
“This system does not reflect innovation in facilities such as how well pressure ulcers are healed, whether centers provide pressure ulcer prevention services, or how well a center works to reduce pain,” she said. “There is no measure for what rehabilitation programs and services are offered to patients, which is the reason the majority of our patients come to HCR ManorCare facilities.”
Kitty Zody, director of nursing at the 38-bed Rose Garden Nursing Home, said her facility did not have as a high level of acuity as some other facilities, and acknowledged there were not many instances of pressure sores.
“Then again,” she said, “we work hard not to have them.”
Zody said the facility tries to keep its staffing levels in accordance with the state of Ohio.
“I think one of the reasons we’ve had a high rating is because our residents are here for a long period of time,” she said. “They do not necessarily come in and then go back home. This becomes their home and they feel it is their home.”
One thing all four agreed on is that the CMS rating system should not be the sole basis for choosing a nursing facility. All said patient satisfaction surveys should be considered, and a visit should be paid to the facility to talk with residents and staff.
“Numbers don’t always tell the story,” said Carnes. “Surveys don’t always tell the whole story. It’s word of mouth, meeting the staff. Before people make a decision to place someone in a facility, they really need to go visit it to get a better indication.”
On the CMS Web site, Kerry Weems, CMS acting administrator also said that because conditions can change within a nursing home at any time, the rating system is just one of many tools families should use when choosing nursing care.
The Web site states the rankings will be updated monthly, and also gives the strengths and limitations of information collected. For more information visit HHS.gov or Medicare.gov/NHcompare.
