Mixed Reception for Nursing Home Ratings

November 18, 2002
Barely a month after it cut Medicare payments to nursing homes by 10 percent, the federal government published its first report on the quality of care at 17,000 nursing homes around the country.

In full page newspaper advertisements and on its Web site at www.medicare.gov the Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) published report cards on 10 measures of performance or quality, including the percentage of residents who have bedsores, are in restraints or have pain or symptoms of acute confusion or delirium.

HHS Secretary Tommy G. Thompson called it "a new approach" and said it would help nursing homes identify areas that need improvement while helping consumers make more informed decisions.

"We support this initiative," said William L. Minnix, Jr., D.Min., president of the American Association of Home and Services for the Aging (AAHSA), a national organization of nonprofit aging services providers. "We welcome CMS' development of a technical assistance program to help nursing homes improve their quality of care, and we support the public disclosure of quality measures to help consumers make more informed decisions."

AAHSA is encouraging consumers to view the federal agency's quality measures on the Internet as a starting point for asking further questions about a nursing home's quality of care, much the way families use college rankings as one tool - but by no means the only tool - in choosing higher education.

"There is no substitute for personal visits and using your five senses in evaluating a nursing home," said Minnix. "A good nursing home is pleasant and inviting, and bustling with activity."

Dr. Charles H. Roadman II, president of the American Health Care Association (AHCA), which represents commercial nursing homes, said Medicaid's reimbursement rate averaged $4.40 per hour -- not nearly enough to cover the costs of providing quality care.

"You can't even get a baby sitter for $4.50 an hour," The New York Times quoted Roadman as saying.

The National Citizens' Coalition for Nursing Home Reform commended the government's effort but noted that despite the "clear link between staffing levels and the quality of care," the initiative does not include a staffing measure.

"We applaud the Nursing Home Quality Initiative, which should alert consumers to the substandard conditions in many of America's nursing homes," said Donna Lenhoff, the coalition's executive director. But she cautioned that the quality measurements are only one aid families should use in selecting a nursing home.

"No one should choose a nursing home without visiting it and observing firsthand the quality of care -- whether residents are responded to quickly when they call for help and whether staff treat residents with respect and kindness," she said. "Families should be wary of facilities that are dirty or smell bad, or where residents are confined to wheelchairs and beds with physical restraints."