The Department of Health and Human Services today published its first detailed quality-of-care information for nursing homes in six states. It's the first step in what is planned to be a nationwide database designed to help older people and their families make the best choice. It also aimed at motivating homes to improve their performance.
But the rating system is already facing criticism. The administrator of one home in Rhode Island that fared poorly called it "unfair," in part because it doesn't take into account the condition of the patient when he or she arrived.HHS Secretary Tommy G. Thompson said that release of the data marks "a red-letter day" for the agency.
"We hope to be in all 50 states this fall, and if it works, we will move to other health care providers," he said at a news conference today.
Information on nine quality measures for nursing homes in Colorado, Florida, Maryland, Ohio, Rhode Island and Washington will be posted on the Medicare Web site. It will also be available through a help line, 800-MEDICARE (800-633-4227). HHS is also running full-page newspaper advertisements in the six states tomorrow to publicize the program.
The nine quality measures fall into two categories -- six for long-stay residents, three for short stay residents. The long-stay measures are: percentage who need more help from staff doing daily activities; percentage who have certain types of infections; percentage who have lost too much weight; percentage with very bad pain at any time or moderate pain every day over the last seven days; percentage who are reported to have at least one bedsore; and percentage who are in physical restraint daily.
The three short-stay measures are: percentage of short-stay residents who have symptoms of delirium; percentage of short-stay residents with very bad pain at any time or moderate pain every day over the last seven days; and percentage whose walking has improved.
The idea, says Tom Scully, administrator of the Centers for Medicare and Medicaid Services (CMS), which runs the program, is that prospective residents will use the information to compare the suitability of nursing homes for people with specific needs. Another hope is that the program will inspire improvements, he says.
"Measurements work in every field of economics, and they should work in health care," Scully says. "We are hoping that as nursing homes look at the charts and see room for improvement, they will take the necessary steps."
CMS has routinely collected all this information and more, Scully says, because of Medicare and Medicaid financing of nursing homes. Reports of nursing home inspections are already on the site. It took months for an independent organization, the National Quality Forum, to select the information to be included in the program, a delicate choice done in consultation with major players in the nursing home industry.
The data release was announced at a press conference including representatives of the American Association of Homes and Services for the Aging, which represents 5,600 nursing homes; AARP, formerly the American Association of Retired Persons; the American Health Care Association; and the union representing nursing home workers.
The quality measures should not be the only data used to choose a home, several speakers said. They do not include some important indicators, notably staffing ratios and consumer complaints. And the data are subject to change, Scully says. Staffing information might be added this fall, he says, and "one or two measures might be added. We'll see how it works out."
The administrator at the Rhode Island home, who spoke under the condition of anonymity, already thinks it isn't working out. Her home was listed as having more than three times the state average of residents with bedsores.
The problem, the administrator said, is that many of these residents come straight from a hospital and have bedsores -- and pain -- when they first arrive. Although the home can get rid of the pain and the sores quickly, "it gets put into a computer even if they're cleared up," the administrator said, so the home gets a black eye from the start.
"Unfortunately, the system they came up with is unfair," the administrator said.
What to Do:
Checking published information is just one step in choosing a nursing home. Visiting the home several times to check on its ambiance is also essential. Medicare has more information about nursing homes, including inspection reports. You can also try the American Association of Homes and Services for the Aging.