Nursing home rating system under way

By: Tammie Smith | Richmond Times Dispatch
Published: December 20, 2008

If new Medicare ratings are on the mark, more than half the adult nursing homes in the Richmond region are of below-average quality.

Only one adult nursing facility, the Health Care Center at Brandermill Woods in Midlothian, earned five of a possible five stars -- denoting performance that is "much above average" -- in the federal agency's new consumer-friendly rating system.

The system was launched Thursday and is available online at www.medicare.gov. (Children's Hospital on Brook Road in Richmond also was included in the ratings and earned five stars for overall quality. Its long-term care unit is for pediatric patients.)

Consumer advocates believe the star rating system is a useful tool, but nursing-home industry folks are not so sure, raising concerns about the methodology used to calculate the ratings and calling it misleading.

Of the 36 adult nursing homes within 50 miles of Richmond that were rated, four earned four stars, denoting above-average performance overall, and seven earned three stars, or an average rating. The rest were below average or much below average, while two were too new to be rated.

Nationally, of the 15,800 nursing homes rated, about 12 percent earned five stars. About 22 percent scored at the bottom.

"This gives consumers a user-friendly tool that will be effective in helping them select nursing homes," said Thelma Bland Watson, executive director of Senior Connections, The Capital Area Agency on Aging.

Nursing-home industry groups say the rating system has shortcomings.

"You can get a general idea, but by and large the data in the system is flawed so the stars don't help much," said Stephen Morrisette, president of the Virginia Health Care Association, which lobbies for nursing homes.

"When a surveyor goes into a nursing facility they are looking at 150 different areas of operations," Morrisette said. "A facility may have 149 that are exemplary and the other one is less than optimal. They are going to get a deficiency. The only thing the public is going to know is they got a deficiency in one area. They are not going to know that the facility was excellent in 149 other areas."

Medicare has been making nursing-home quality information available online for some time, but consumers had to muddle through a lot of information to get a sense of a facility's quality. Morrisette said the star rating system arose from a congressional mandate to simplify the information.

The rating system is based on observations of state and federal inspectors who go in periodically to check on nursing homes or who go in response to specific complaints. Staffing and other measures, based on facility reported data, also are considered. The data will be updated quarterly.

Morrisette said personal visits and satisfaction surveys are better ways to decide on a nursing home.

"The best way to check on any long-term care facility is to visit it. Go in and observe the attitude of staff, how they are caring for residents. You should not use the star system to determine where your loved one or you should go," Morrisette said.

In a statement from the Centers for Medicare & Medicaid Services, acting administrator Kerry Weems also noted limitations.

"Because quality and conditions within a nursing home can change at any time, this system is not intended to be the only tool families use in selecting the right nursing facility for a loved one," Weems said.

At the only adult nursing facility in the Richmond area to get five stars, staff were pleased.

"Isn't it great," said Tracey Daniels, administrator of the Health Care Center at Brandermill Woods. The facility has been in operation for more than 20 years.

"We do a lot of employee-recognition things," Daniels said. "If you take care of them, they are going to take care of our residents."

The nursing home is part of a continuing care community that also has 197 independent-living and 92 assisted-living units. The facility is run by nonprofit Senior Living Choices Inc.
Contact Tammie Smith at (804) 649-6572 or TLsmith@timesdispatch.com.