Use New Medicare Facility Ranking System as a Tool Not a Rule

  • Nursing home administrators are worried, and for good reason. The new Medicare nursing home comparing site at has gone live. Nursing homes are given ratings, from one to five, in four categories. This is a simple rating system for complex elder care centers. Please use this as a tool, but use it with great care.


    I knew this rating system would result in problems. Many privately run rating sites have been online for years, as have many county inspection rating sites. I've often checked the ratings and compared them to what I see and hear locally.


    I write a column in a medium sized newspaper that has a broad readership in two states. I receive dozens of e-mails every day from local readers of the column, as well as readers of this site and of my other national work, so I have a fair overview of the quality of homes nationally, though not specific homes out of my area. Let's say I've heard horror stories about facilities that wouldn't last a day in North Dakota or Minnesota. There are some very bad nursing homes around the country.

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    However, when choosing a care center, the criteria most people instinctively use is that of the level of family satisfaction. And from what I hear and read, if the ratings of the nursing homes in my area are any example, this new Medicare rating system has a lot of tweaking to do to be useful. They need at least one other category - family satisfaction. People also need to be aware that this rating is a one-time snapshot. The numbers could be totally different in another month.


    For over 15 years, I had from one to three loved ones in a home just two blocks away from where I live. I visited every day. I knew the staff at the nursing home, and still am in contact with some of them. They cared lovingly for my family members, some of whom suffered from very difficult conditions. I saw them also care lovingly for many other elders, some of whom were quite difficult to love.


    Was the home perfect? No. At the time, while the physical plant was very well kept, it was in need of modernizing. That has since been done (my family jokingly calls the new addition the "Bradley Wing," as every cent my parents had went into that facility. But we have no regrets).


    The remodeling was being done as my last elder, my mother, was nearing death. I asked her if she wanted to have a new room, but she declined. She was used to her room, liked her window by her bed and didn't want to move. She died not long after the new wing opened.


    Once the new wing opened, the staff moved residents to the new area and the rest of the building was remodeled, creating a locked memory floor, among other improvements.


    Okay, I'll name the center. It's Rosewood On Broadway, in Fargo, North Dakota. Rosewood has a savvy young administrator who was first a nurse, and is not above wiping a runny nose or settling someone in a chair as he walks around visiting residents. He makes the rounds of all the floors, including the adult day care (they also have a child care center there), and knows the residents by name. They also know him as a friend.


    The building is clean, beautiful and efficiently run. They rated four stars on staffing, which is a huge issue for most homes, and four starts on quality measures - whatever that is. They rated one star on health inspections.


    I'm not sure why they fell down on this, but I will say that I've witnessed the incredibly complex health inspection system in the past, and my guess is that the infractions are very small. One large problem with all of these ratings, especially the health inspections, is that every state has different rules. And North Dakota is very strict. That's a good thing. But it can make a good facility look bad, on a national level. Some things are also subjective, and the rating depends on the person doing the inspection (think real estate appraisal).

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    That is the problem. What were the infractions at Rosewood? They are not listed. Was butter left out on a table too long or was someone with a horribly contagious disease sitting in the common room? We don't know.  Knowing Rosewood as I do, I would bet that the infraction was more closely related to the butter than the disease. I also know they will address any issues that brought their rating down, and next month they will likely have fixed the errors.


    Sometimes, in order to give outstanding, personalized care, a nursing home must break some health code which may make sense under some circumstances but not others. Knowing this care center as I do, my guess is that the people came first and some choices made to care for their residents physical, emotional and/or spiritual needs may have put them at risk during inspection time. These caring people would have chosen to care for the immediate needs of the resident first, and worried about inspections later.


    Please don't get me wrong. This Medicare rating site is a good first step, but it's far too simplified.  If what I consider a topnotch facility like Rosewood ends up with a "2" rating (after the categories were averaged), I shudder to think what care centers in other parts of the country are like. Will there be minus ratings? Unless the system starts to use family satisfaction as a tool in the rating system, they'd better start to allow for minus ratings.


    I'd love to bring a family that went through a facility that got a "4" in one state to tour Rosewood and talk with staff, family and residents. They'd be begging to get their loved one admitted.


    The homes in my area all have waiting lists. Rosewood's is among the longest. Word of mouth from families has made it that way. Other fine homes in my area - homes I know - received ratings similar to Rosewood's. 


    Our major hospital ranked high. Well, folks, that's a hospital and I'm delighted. However a hospital is not a home. The criteria must be different for nursing homes - not slack, but different -  if the new resident centered care centers are to evolve in such a way where elders are actually living in a home and not in an institutional setting. 


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    Good for Medicare for developing this new system. But please just consider it one source of information. Ask for references about a specific home. Do your own inspection. See how the staff is treated by other staff (my mantra - are the all-important, hands-on CNAs treated with respect by the nurses and administrators?).


    Are the residents occupied if they choose to be? Are they dressed and clean (within reason)? Are they offered choices for meals at times their ailing bodies can take in food? Are they treated with respect? Is their dignity protected?


    Are they treated like they are living in their home, or are they treated like a hospital patient - or worse yet, ignored?


    Stop in unannounced, to a home you are considering, at different times of the day and evening. What do you see? How do you feel about the care when you aren't there as an expected visitor?


    Yes, use the new Medicare tool. But don't take a five star center because it got five stars. And don't dismiss a two star facility. If you use just this tool, you will be looking long and hard to find any care at all for your elder. And you may pass up one of the best facilities available because of a technicality in the system.


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Published On: December 24, 2008