New ratings on nursing homes are outdated and flawed, and don’t convey the real quality of Maine facilities.

As a whole, Maine nursing homes outscore the national average under the federal government’s new 5-Star Quality Ratings System, with more than 20 percent of homes earning five stars, only 8 percent with one star and a near-even distribution of 2-, 3- and 4-star homes.

Readers may recall that nursing home health inspections, staffing levels and quality measures are considered to arrive at the number of stars a home receives on the Centers for Medicare and Medicaid Services’ “Nursing Home Compare” Web site.

We are unsurprised to see Maine facilities fare well, because our nursing homes are committed to providing high-quality care to their residents in a safe and secure environment. Maine homes are in the top five nationally for their voluntary participation in Advancing Excellence in America’s Nursing Homes.

Advancing Excellence requires homes to set specific quality improvement goals with measurable clinical outcomes and report the results regularly. Maine nursing homes consistently outscore national counterparts in customer satisfaction, with 91 percent of family survey respondents giving their nursing home an overall rating of either “excellent” or “good” and 91 percent also indicating a strong willingness to recommend to others the facility where their loved one is receiving care and services.

Despite these honorable achievements, we remain concerned about the accuracy and usefulness of the Centers for Medicare and Medicaid Services’ new quality rating system. This “new” system is based on an eight-year-old research study that does not reflect progressive trends or recent clinical achievements in facility care.

There are several fundamental flaws:

• CMS claims the health inspection component of its 5-Star Quality Rating System represents the most important dimension in determining a facility’s overall quality.

We disagree – today’s health inspection, or survey, system does not directly measure quality, but rather assesses compliance with federal and state regulations. Since the survey process is subjective, CMS acknowledges on its Web site that the 5-Star system cannot be used to compare homes across state lines.

• We are also aware that CMS has used incomplete and inaccurate data for some facilities, which contributes to false ratings for some homes, including several in the Sun Journal readership area. For example, some facility survey results are more than six months old, which does not necessarily reflect how the facility is currently operating.

CMS has also included ratings on two nursing homes in Maine that have closed, one of which earned a 1-star rating according to the Web site.

• The 10 quality measures used by CMS to contribute to the quality star are appropriate, but there are 19 total measures. In addition, these quality measures are only a snapshot in time and change regularly based on nursing home residents’ acuity and health status.

• And perhaps the most troublesome flaw with a 5-star approach is that it likens selecting a nursing home for a loved one to choosing a restaurant or hotel. These are not parallel decisions; choosing long-term health care is a monumental decision that should be made with great thought, research and care.

We will continue to advance a transparent survey process that recognizes quality and provides resources for facility improvement, which will enhance efforts to sustain quality long-term care. However, we believe residents and their families should also have a strong voice in this process. CMS does not take their opinions and experiences into account, yet they are very good indicators of quality care.

Finally, we strongly encourage consumers to visit facilities firsthand, ask questions and talk with residents and staff. Consumers should also seek advice from medical professionals and trusted friends and family members before choosing a home.

A ratings system is not a substitute for doing your homework.

Richard Erb is president and CEO of the Maine Health Care Association. E-mail [email protected]


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