After the new ratings posted on Friday on the government’s Nursing Home Compare website, almost one-in-three nursing homes around the country have received lower scores on the official five-star quality scale. More than 15,000 care facilities were assessed after the tougher standards.
The new ratings represent the sweeping changes made in the way care facilities are being evaluated. One of the important difference was made in the way anti-psychotic drugs are used, due to the serious risks it poses for older adults, especially for those who struggle with dementia. The new standards have also made changes in measuring proper staffing, one of the most important factors of good care.
More than 60 percent of all nursing facilities have received lower scores, based on the improved metrics, but most of the declines did not have a large impact in the overall ratings of the facilities. However, more than 1,200 nursing homes lost one star from their general rating, and 3 percent of them dropped two stars.
These ratings are important indicators of the quality of nursing home, and they help people decide in favor of one or another. Last year, for example, more than 1.4 million people checked the Nursing Home Compare website in their search for a care facility. Therefore, ratings are very important because they reflect their performance; good ratings can also be used for marketing purposes, in presentation brochures.
The new standards are part of the continuous improvements that need to be made in nursing home care, even though they haven’t been altered since 2008. Since then, almost all care facilities have reached five-star status, so upgrading the way care facilities are being rated is important for stimulating them to always raise their standards.
Patrick Conway is the chief medical officer at the federal Centers for Medicare and Medicaid Services, and also administers the Nursing Home Compare website. He commented upon the new ratings, saying that the lower ones are not signs of improper care; it just shows that standards have improved, and higher quality should be recognized.
Three important categories were tested for the new ratings: staffing levels, performance in state inspections and quality of care. The biggest changes in scores were in the latter category, which reflect the addition of data on anti-psychotic drugs. A shocking 20 percent of all nursing homes received the lowest score on the new standards for the use of these drugs. The new measures state that residents should be administered anti-psychotic medicine only if they suffer from conditions like Tourette’s Syndrome, schizophrenia, or Huntington’s Disease.
Groups advocating for the well-being of nursing home residents and their families have greeted the new standards with open arms. Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, has expressed his concerns about the over-inflated ratings in the past couple of years, which seemed to falsely advertise the facility’s quality and staffing. He went on record stating that improved scoring measures will surely result in more accurate reflections of the quality of care.
The new measure on the use of anti-psychotics had eager supporters among advocates for nursing home residents. Grant explained that high scores in the use of anti-psychotic could suggest serious care issues, because the staff might use them to drug residents, instead of properly taking care of their needs. Inadequate administration of anti-psychotics increases the number of falls, causes immobility, which in turn increases pressure ulcers.
On the other side of the story, there are the nursing homes owners who fear that future customers won’t know what to make of the lower ratings. They won’t know that standards have changed because many facilities have improved their care quality, and that needed to be recognized. Mark Parkinson, CEO of a nursing home industry group called the American Health Care Association, says that sudden drops in star ratings across the country send the wrong message to residents and families, who will start thinking that quality is decreasing, when in fact, it has improved in a very significant way.
Patrick Conway assures the public that the ratings system will receive more regular updates in the coming years, the next being right around the corner, in 2016. CMS is working hard in making sure that the self-reported data on quality and care reflects the actual situation of a facility.
Conway has stressed the importance of relying on multiple factors when choosing a nursing home. While the new ratings system improves the image presented by the care homes, people should consider tapping other resources. They could contact a local long-term care ombudsman, or get feedback from relatives or current residents before making a decision. But most importantly, make a visit at the care facility you’re interested in. Nothing can substitute spending time in the building you’re considering.
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