In my original blog post, I shared a tip about www.medicare.gov/nursinghomecompare, a website I found that I believed would help
caregivers find better nursing homes. This post is about an article I
read concerning nursing home staffing levels. You can skip
ahead to "New Resources for Caretakers" if time does not allow you to
read on.
After reading "Nursing Home Care Levels May be Much
Lower Than Families Think" by Jeff Kelly Lowenstein of the Center for
Public Integrity published on November 12, 2014, I realized that the data on
the website may be somewhat flawed or worse. You can read this
article at http://www.nbcnews.com/news/investigations/nursing-home-care-levels-may-be-much-lower-families-think-n246431.
On the www.medicare.gov/nursinghomecompare website, there are three levels that determine the overall rating of nursing homes from one to five stars, five being the best. The overall "star" rating is comprised of the combined rating for Health and Fire-Safety Inspections, Staffing and Quality Measures. The article I am writing about discusses staffing levels which I believe is the most important part of the overall rating.
All the data used to determine the overall rating is
reported to Medicare by nursing homes. According to Jeff Kelly
Lowenstein, after analyzing the data sent by nursing homes, the Center for
Public Integrity found that thousands of nursing homes had
reported staffing levels that were higher than the data reported to Medicare
which means the staffing rating is lower that what is reported on the www.medicare.gov/nursinghomecompare website.
Per the article, "The discrepancies raise profound
questions about the accuracy of the information in the so-called Nursing Home
Compare website that many consumers use to pick a nursing home for family
members. The reporting discrepancies occurred for all types of positions, but
were particularly high for registered nurses, the most skilled and highest paid
workers."According to www.medicare.gov/nursinghomecompare the data used for staffing levels was self-reported by nursing homes to their state survey agency during a two-week period prior to state inspections. "Staffing hours are reported by nursing homes and displayed as the number of staff hours per resident per day calculated by the total hours worked divided by the total number of residents.
I'd like to advise that users of this website should not assume
that this number reflects nursing staff present or the amount of care given to
any one resident, and should also realize that the staffing hours/level may
have changed after the numbers were reported.
For these and other reasons, this apparently has been a
problem since staffing levels began to be reported in January, 2012 as stated
in a report I found on the State of New Jersey, Department of Health website
entitled, “Nursing Home Staffing Level Report to Improve Transparency, Empower
Consumers" http://www.state.nj.us/health/news/2012/approved/20120723b.html.
Staffing levels are critical for resident care for many
reasons. Reported in almost 100 academic studies, residents' quality
of care is strongly related to the amount of care received. Since
registered nurses are the most experienced and highest paid, these positions
are more frequently understaffed. Injuries and even death are more
likely when lower levels of care exist due to understaffing or not enough
experienced staff.
In addition, staffing levels can vary based on many factors,
for instance, nursing homes that care for more seriously ill or
injured patients would have more staff. In addition, overtime is
often reported which would lower the ratio of patients per RN/LPN because
it looks as if there are more staff, but that isn't accurate.
According to the Nursing Home Nursing Staff Report at http://www.nj.gov/health/healthcarequality/nhstaffing.shtml,
also very important but not included in staffing level data are clerks,
administrators, housekeeping staff, etc.
Per www.medicare.gov/nursinghomecompare/data/datasource, the data used for rating the nursing homes comes from
two sources. The first source is the CMS Health Inspection database
"which includes the nursing home characteristics and health
deficiencies issued during the three most recent state inspections and recent
complaint investigations. Data about staffing and penalties levied against
nursing homes also come from this database.”
Issues found during health and
fire-safety inspections, complaints and penalties reported can be
viewed and read on the website. I read many of the complaints and reports
when researching Lincoln Park Care Center where my husband is currently living,
as well as others while trying to find a better place for my husband to
live. I think that these reports are the best part of the website since
they are actual reports that cannot be skewed or exaggerated.
Quality Measures come from data that is regularly collected
by nursing homes and are based on care given to all residents and not on
individual residents. Most of the quality measures were reported in the
week prior to the assessment, and may not reflect patients' conditions prior to
or after the week in question. For these and other reasons
stated below, I question the usefulness of the Quality Measures
rating.
The second source of data comes from a national database
called the MDS (Minimum Data Set) Repository. Data for quality measures
come from the MDS database. In order to be certified by Medicare and
Medicaid, nursing homes perform periodic assessments on every resident by
collecting information about the resident's health, physical functioning,
mental status, and general well-being. "These data are used by the nursing
home to assess each resident's needs and develop a plan of care."
A disclaimer on the www.medicare.gov/nursinghomecompare
website states, "All of these data are reported by the nursing homes
themselves. Nursing home inspectors review it, but don’t formally check it to
ensure accuracy. This information changes frequently as residents are
discharged and admitted, or residents' conditions change. The information
should be interpreted cautiously and used along with information from the Long
Term Care Ombudsman's office, the State Survey Agency, or other sources."
Since many nursing homes work hard to prepare for these
inspections, and for the reasons stated above, unless another way can be found
for reporting staffing levels, I think they should not be used as part of the
rating system because as "critics say, those staffing levels may
be artificially inflated."
New Resources for Caretakers
Thanks to this article and more research, I have a lot more
resources to share for caregivers:
·
http://www.carepathways.com/nhg-state-survey-agency.cfmhttp://www.nj.gov/health/cancer/documents/data_release_policy.pdf
· http://money.usnews.com/money/personal-finance/articles/2014/05/07/5-traits-of-the-worst-nursing-homes (look out for these red flags when checking
into nursing homes)
No comments:
Post a Comment