What Does a Five-Star Rating Really Mean?

The New York Times placed Medicare’s nursing home rating system front and center in a recent, in depth article, by Katie Thomas, and a recent editorial . In the past, I have written about Medicare’s rating system, pertaining to New York State nursing homes. While The Times article mentions nursing homes in New York, it focuses on nursing homes in California, specifically Rosewood Post-Acute Rehab, which has a five-star rating despite having over 100 consumer complaints and around a dozen lawsuits filed against it.

Nursing home ratings, like Rosewood’s, cannot be taken at face value because much of the data behind them is self-reported and can be changed or misreported by facilities’ employees. The ratings are determined by three criteria, staff levels, quality statistics and health inspections. The Times editorial acknowledges that staff levels and quality statistics “are reported by the nursing homes and accepted at face value by Medicare without verification.” If this data is not authenticated by Medicare, facilities can easily get away with manipulating it for their benefit.

The data from annual health inspections, while not self-reported, can be manipulated, as well. Nursing homes often know when inspections will occur, and increase staff hours during the inspection, only to decrease them once the inspection was complete. The administrator of Medford Multicare Center for Living, a facility in New York, described the inspection period as “our Super Bowl.” The current rating system seems to shift the focus and effort of nursing home staff and administrators to obtaining high ratings, and away from providing consistent, quality care.

In an attempt to rectify part of the problem, the Affordable Care Act “requires Medicare to use payroll data to verify the accuracy of staff levels.” However, the agency, “still working on the verification system,” has not yet put this requirement into effect.

Even though the rating system is imperfect, Katie Thomas writes that, starting this year, Medicare plans to use a comparable system for hospitals, dialysis centers and home-health-care agencies. While the five-star rating system makes it easy for families and loved ones to compare facilities, these recent stories show that the data behind the ratings are not always accurate. When deciding on a nursing home, be sure to look beyond the ratings. They do not always represent the true quality of care.

Woman in Assisted Living Facility dies after being denied CPR

There is no legal requirement for licensed nursing staff to perform CPR; however, it is the Standard of Care in New York State among licensed nursing staff.

Authorities are launching a criminal investigation into the death of an 87-year-old woman who was denied CPR at a California independent living home by a woman who identified herself to a 911 dispatcher as a nurse – but the facility now says she isn’t one.

During the call last Tuesday, an unidentified woman called from her cell phone, and asked for paramedics to be sent to help Lorraine Bayless, who collapsed in the dining room of the independent living building in Glenwood Gardens in Bakersfield.  Later, a woman who identified herself as the nurse got on the phone and told dispatcher Tracey Halvorson she was not permitted to do CPR on the woman.

She said one of the home’s policies prevented her from doing CPR, according to an audio recording of the call.  ”In the event of a health emergency at this independent living community, our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives,” Executive Director Toomer said. “That is the protocol we followed.”

The harrowing 7-minute, 16-second call also raised concerns that policies at senior living facilities could prevent staff from intervening in medical emergencies. It prompted calls for legislation Monday to prevent a repeat of what happened at Glenwood Gardens.

“This is a wakeup call,” said Assemblywoman Mariko Yamada, chair of the California Assembly Aging and Long-term Care Committee. “I’m sorry it took a tragedy like this to bring it to our attention.”

In New York State we have the Assisted Living Reform Act (“ALRA”) with corresponding regulations. In reviewing both New York State regulations and ALRA, I was unable to find a requirement that CPR be performed.  There was a proposal submitted by the Department of Health for a licensed registered nurse to be on staff 24 hours a day at assisted/independent living facilities; however that proposal was successfully challenged and there is still no requirement in place.  Had such a regulation been effective, then that staff member would have been in a position to perform CPR.

Below is a link to the article:

http://www.foxnews.com/us/2013/03/05/spokesman-says-woman-who-refused-to-give-cpr-to-dying-87-year-old-wasnt-nurse/