December 21, 2014

Nursing home ratings sometimes misleading

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Residents sit around a table during a knitting activity session as Clark-Lindsey Retirement Village on Nov. 7, 2014. Clark-Lindsey in Urbana and Country Health in Gifford are the only five-star facilities in Champaign County.

Darrell Hoemann/CU-CitizenAccess.org

Residents sit around a table during a knitting activity session as Clark-Lindsey Retirement Village on Nov. 7, 2014. Clark-Lindsey in Urbana and Country Health in Gifford are the only five-star facilities in Champaign County.

Since 2011, dozens of central Illinois nursing homes have improved their five-star Medicare rating, some by as much as four stars.

But that improvement, some critics say, is not an accurate representation.

“I don’t trust any of the ratings that are online,” said Ben Neiburger, a Chicago-based elder-law legal specialist and principal partner of the firm Generation Law. “I mean, I suppose there’s a difference between a five-star place and a one-star place, but the rest of them, who knows?”

A review of inspections shows that an above average rating does not necessarily mean a nursing home has not been cited for problems.

For instance, Symphony of Decatur has a four-star rating, according to Medicare data released in August. Recent Illinois Department of Public Health inspection records show the facility failed to protect food from potential contamination. In December, inspectors observed gnats “flying around the juice dispensing machine” and “on the serving utensils” hanging on a rack. They also noted a ventilation hood had peeling and flaking black paint, which “could fall into the food.”

In Palm Terrace of Mattoon – another four-star home – inspection records show that employees were improperly using restraints “not necessary to treat a medical symptom, but rather for staff convenience.” The practice of using wheelchair restraints or bed restraints is prohibited by federal regulation, unless used for a specific medical reason.

A CU-CitizenAccess.org comparison of 2011 and 2014 overall ratings from 72 central Illinois nursing homes shows that 32 facilities improved their scores from years ago, with most going up by a single star.

Nineteen nursing homes received lower overall ratings, and a handful dropped by as many as three stars on the scale.

The five-star Medicare system – which is based on staff levels, inspections and quality measures – has long been criticized from both nursing-home advocates and nursing-home administrators alike. Advocates argue the system lets seemingly well-to-do homes get away with serious problems, including understaffing. Administrators claim it penalizes high-functioning facilities for not having glamorous looks.

Matt Hartman, vice president of public policy for the Illinois Health Care Association, said the system is a subjective “gotcha system” based on arbitrary geography and blind measures. For example, he said, a nursing home that specializes in treating bed sores may get “dinged” for having many residents with bed sores, a quality measure inspectors look for.

Nursing homes are inspected annually and in response to formal complaints.

“I think there’s no rating system that exists that’s going to be entirely objective, and the five-star rating system is certainly in that category,” Hartman, whose organization is made up of hundreds of long-term care facilities, said. “There’s a lot of subjectivity to it.”

The skepticism surrounding the five-star system led federal lawmakers to pass the IMPACT Act of 2014 in October. One of the key changes under the act will require nursing homes to submit staffing data quarterly to improve accuracy. The data, although still self-reported, will also have to be verified by payroll records.

“With the new law, what’s going to happen is that staffing will actually be able to be input electronically,” said Tami Wacker, a resident-advocate and regional ombudsman for the East Central Illinois Area Agency on Aging. “So those types of things will be measured up.”

Reporting changes will go into effect next year, but they will not be reflected in the ratings until 2016.

“It’s much easier to go down on the five-star than it is to go up,” said David Voepel, who works with Hartman as the executive director of the Illinois Health Care Association. “In some cases, it can take up to two years for them to go up just two stars.”

Star power: comparing central Illinois nursing homes

Sullivan Rehabilitation and Health Care Center in Moultrie County and the Odd Fellow-Rebekah Home in Coles County both improved from a one-star home to a five-star home.

Asta Care Center of Colfax in McLean County, Mason Point in Moultrie County, Mattoon Rehabilitation and Health Care Center in Coles County, and Heartland of Paxton and Illinois Knights Templar Home in Ford County all dropped by three points.

A review of the seven Medicare-certified Champaign County nursing homes shows that Clark-Lindsey Retirement Village and Illini Heritage Rehab and Health Care were the only county facilities that improved on the rating scale from 2011 to 2014.

“I think the difference at Clark-Lindsey comes from the culture we have here,” said Deb Reardanz, the president and chief operating officer at the five-star facility. “Our team members, our employees, the residents and anybody that is part of the Clark-Lindsey family sees our residents, our patients as a whole person.”

While rating can serve as a starting point, Neiburger – a member of the National Academy of Elder Law Attorneys – said families should visit each home and observe the environment before trusting the online ratings.

“You don’t know unless you’re there,” he said.

Additional reporting by Claire Everett/CU-CitizenAccess.org