For the first time, the federal government is shining a spotlight around the quality of rehabilitation care at nursing homes – services utilized by nearly Two million seniors each year.
Medicare's Nursing Home Compare website now includes a “star rating” (a composite way of measuring quality) for rehab services – skilled nursing care and physical, occupational or speech therapy for individuals dealing with a hospitalization. The site also breaks out 13 measures from the quality of rehab care, offering a far more robust view of facilities' performance.
Independent experts and industry representatives welcomed the alterations, saying they might help seniors make smarter decisions about where to seek care following a stay in hospital. This matters because high-quality care can help older adults regain the opportunity to live independently, while low-quality care can compromise seniors' recovery.
“It's a really positive move,” said David Grabowski, a professor of healthcare policy at Harvard School of medicine. He noted that previous ratings haven't distinguished between two groups in nursing facilities with different characteristics and needs – temporary residents getting short-term rehabilitation and permanent residents too ill or frail to reside independently.
Temporary residents are trying to regain the opportunity to care for themselves and return home as quickly as possible, he noted. By contrast, permanent residents aren't expecting improvements: Clients meet to keep the highest quality of life.
Three separate ratings for the quality of residents' care now appear on the Elderly care Compare website: one for overall quality (a composite measure); a different one for “short-stay” patients (individuals who reside in facilities for 100 days or less, getting skilled nursing services and physical, occupational or speech therapy) along with a third for “long-stay” patients (people who reside in facilities for more than 100 days).
Ratings for short-stay patients – readily available for 13,799 nursing homes – vary considerably, based on a Kaiser Health News analysis of data published by the government in late April. Nationally, 30% of nursing homes with a rating received five stars, optimum. Another 21% got a four-star rating, signifying above-average care. Twenty percent got three stars, an average performance. Seventeen percent got two stars, a worse-than-average score. And 13% got one star, a bottom-of-the-barrel score. (Altogether, 1,764 nursing homes didn't receive ratings for short-stay patients.)
Here's information about how to locate and employ the new Nursing Home Compare data, as well as insights from Kaiser Health News' analysis:
Finding data about rehabilitation. Enter your geographic location on Elderly care Compare's webpage, along with a list of facilities will come up. You can select three at any given time to examine. Once you've done this, hit the “compare now” button at the top of the list. (To determine more facilities, you will need to do this again.)
A new page will appear with several tabs. Click the one marked “quality of resident care.” The 3 overall star ratings described above can look for that facilities you've selected.
Below these details, two choices are on the left side: “short-stay residents” and “long-stay residents.” Click on “short-stay residents.” Now you'll see 13 measures with actual numbers included (most but not all of the time), as well as state and national averages.
Understanding the star rating. Six measures are utilized to calculate star ratings for the quality of rehab care for short-stay patients. A couple of them concern emergency room visits and rehospitalizations, potential indicators of problematic care. Another two examine how good discomfort was controlled and bedsores were managed. One measure looks at how many patients became able to better move about by themselves, an essential component of recovery. Another examines the rate where antipsychotic medications were newly prescribed. (These drugs can have significant side effects and are not recommended for older adults with dementia.)
One way of measuring great interest to seniors may be the number of residents who return successfully home following a short nursing home stay. But actual numbers aren't on the Nursing Home Compare website now: Instead, facilities are listed as substandard, average or above average. The nation's average, reported in April, was 48.6%, indicating room for improvement.
Tracking variations in performance. Some facilities outperform others by large margins on measures of quality of care for short-stay residents. Plus some facilities have high scores in certain areas, but not in other people.
For instance, the elderly care at Westminster Village, a high-end continuing care retirement community in Scottsdale, Ariz., had the highest score for rehospitalizations – 39.9% – from 68 facilities in and around Phoenix. (By contrast, the cheapest score within the Phoenix area was 15.4% and the state average was 23.5%.) Additionally, it had the greatest rate of helping residents improve their ability to move around on their own – 88.6%. (The cheapest score was 37.6% and also the state average was 63.6%.)
In an email, Lesley Midkiff, marketing director at Westminster Village, said that the facility's staff is vigilant about sending residents to the hospital if health problems arise. Simultaneously, she said, staffers “push the residents just enough to regain independence and recover quickly from their short term stays.” Both priorities have the “residents' best interest” in your mind, she said.
If a facility has an average or low quality score, Dr. David Gifford, a senior vice president in the American Health Care Association, a nursing home industry group, recommended that individuals look closely at various measures and try to determine in which the institution fell short. Call the facility and get them to explain, he explained. Also, review Elderly care Compare's information about staffing and health inspections, Gifford suggested, and go to the facility if at all possible.
Variations within nursing facilities. The newly published Nursing Home Compare data also implies that institutions aren't always equally adept at caring for short-stay and long-stay residents.
Disparities in facilities' ratings for short- and long-stay people are common. Of 13,351 nursing homes that received both ratings, 32% received the same star ratings for that quality of care received by short-stay and long-stay residents. Another 32% of facilities received higher star ratings for short-stay residents, while 36% got higher ratings for long-stay residents. About one-third of the time, these rating categories were one star apart, however in another third of cases, they varied by two or more stars – a substantial discrepancy. (This analysis doesn't include 2,212 nursing facilities for which data didn't have.)
In Phoenix, Desert Terrace Healthcare Center, which bills itself on its website because the city's “premier location for short-term rehabilitation and long-term care,” is one such facility. Its quality-of-care rating for short-term residents was two stars, while its rating for long-term residents was five stars. Notably, hospital admissions and ER visits for short-stay patients were greater than the state average, as the portion of short-stay residents whose mobility improved was lower than average.
In an e-mail, Jeremy Bowen, the facility's administrator, wrote that the facility were built with a good record of managing pain and bedsores and limiting antipsychotic prescriptions for short-stay patients. Factors for example hospital readmissions rely on community resources and patients' understanding of their own health needs, that are hard to control, he noted.
Sierra Winds, part of a consistent care community in Peoria, Ariz., has a similar split in quality ratings (two stars for short-stay residents, five stars for long-stay residents). On four of six measures accustomed to calculate star ratings for short-stay residents, it performed worse compared to state average.
“Sierra Winds remains committed to supplying the highest quality care and services to the residents,” wrote Shannon Brown, the facility's executive director, within an email. “We be proud of our 4-star rating with CMS [the Centers for Medicare & Medicaid Services].”
That's the facility's overall rating (including data about staffing and health inspections). However it doesn't address the split in scores for short-stay and long-stay patients, which raises a red flag and should certainly cause seniors as well as their families to ask follow-up questions.
“If I am a patient searching for a place for a short-term rehab stay, I truly need to know how patients who look like me did,” said Dr. Rachel Werner, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania along with a quality-measurement expert.