How Do You Pick Best Nursing Home?

www.heraldtribune.com

February 2, 2009 

Activities Director Marie Worden, left, cheers on resident Melanie Paschall, center, who returns the ball during a round of volleyball at Sunnyside Village, a highly rated rated Sarasota nursing home. 

On a recent Wednesday, a crowd gathered for a picnic on a sunny patio near the water to eat, drink and listen to live music — though cold weather forced the party indoors.

The setting was no trendy club, but Bay Village retirement community, and the crowd was two dozen of its nursing home residents, average age 92.

That same day, a dozen seniors met in a room at Sunnyside Village, not for bingo, cards or TV, but for volleyball, for fitness and to train for a match against the assisted-living residents.

The Sarasota communities include two of the area’s best nursing homes, both three-time winners of Florida’s gold seal for quality. Finding those quality homes should be easier than ever with the update and re-launch of a new Medicare-backed Web site that for the first time assigns “star” ratings — as found in guides to hotels and restaurants. 

But experts caution that resources are just a starting point and have weaknesses. One example: Medicare’s site does not even list Bay Village.

New offerings

The Centers for Medicare and Medicaid Services, or CMS, announced the revised site last month to praise from government officials and harsh words from the nursing home industry:

“With this new rating system, CMS is improving the ability of consumers to readily obtain critical information,” said Sen. Herb Kohl, D-Wis., chairman of the Senate Committee on Aging.

“A forced simplification of an overly complex formula,” said the American Health Care Association, the leading advocacy group for nursing homes. Its Web site lists “talking points” to help home operators point out flaws to residents’ families and the media. 

The foundation of the ratings system is annual reviews by state or federal inspectors. Those reports — essentially, lists of areas where homes violated care and safety rules — create the base score. The top 10 percent of homes get five stars; the bottom 20 percent get one star. Homes that do particularly well or poorly on staffing and quality — measures of how well residents maintain their abilities — will gain or lose stars.

The nursing home association argues that the ratings rely too heavily on inspections and not enough on staffing or quality.

In Florida, 86 of 679 homes — about 13 percent — received a five-star score, a Herald-Tribune analysis of the data found. In Sarasota, Manatee and Charlotte counties, just 3 of 48 homes, or about 6 percent, received the top rating.

Those three were Sarasota’s Sunnyside Village, and two in Manatee County: Bradenton Health Care, and Heritage Park Care and Rehabilitation Center.

All three also are highly rated in the online nursing home guide compiled by Florida’s Agency for Health Care Administration, or AHCA, which oversees the state’s nursing homes. AHCA has its own recognition program for outstanding nursing homes, the Gold Seal award, now held by just 15 homes statewide. 

The only local homes on the list are Sunnyside and Bay Village — which does not appear in the Medicare five-star list, because the home accepts only privately insured or self-paying residents, not Medicare or Medicaid recipients.

While several studies have found nonprofit homes outperform their for-profit counterparts, the local standouts come from both sides. 

The two Manatee County homes are for-profits — Bradenton Health Care is run by the state’s largest nursing home company, Tampa-based Sea Crest Health Care Management. Neither returned calls requesting interviews about their performance.

Both Sarasota homes are religious-based nonprofits. Sunnyside Village was founded by seven Mennonite churches. Bay Village is a nonprofit owned by Pine Shores Presbyterian Church, founded by its late pastor after he visited his parishioners in substandard nursing homes.

The two also share a commitment to staffing. One-third of Bay Village’s employees have been there 10 years or more. Another third has been there 5 years or more, and turnover is less than 5 percent a year. The home believes that consistency fosters better care.

“We try very hard to keep the same staff with residents, so they learn the residents’ needs and anticipate them,” said Janette Dalton, Bay Village’s chief operating officer, who is also a nurse.

Sunnyside has the same belief, scheduling staff members to work with the same residents, allowing workers to learn residents’ routines and avoid mix-ups. “There’s that special bonding that takes place,” longtime administrator Diane Marcello said.

Some people may have been seen as problem residents elsewhere simply because they kept seeing new staff that did not know them, she said.

Both homes use salary and benefits to retain staff. Bay Village employees pay just $8 per week for full health benefits, and Sunnyside pays the full cost of those benefits, administrators said.

In turn, Bay Village’s nursing home unit had less than 5 percent turnover last year, and two-thirds of its employees have worked there at least 5 years. Sunnyside has employees that have worked there 30 years. 

They also both exceed state staffing mandates and emphasize staff training. Bay Village has some in-house training almost every day, and Sunnyside inculcates its staff in what it calls the “Sunnyside way.”

“We train people from the day they get here,” Marcello said. “We tell them, ‘This is the hardest place to work; are you sure you want to work here?’”

Experts in nursing home quality say you should look for signs of that commitment and not rely on Medicare’s ranking, or any other.

Hard to judge by numbers 

People can find ratings for everything, from the best high-definition television to the best sports car, but they need more than that to choose a nursing home.

“Don’t assume the facility can be reduced to numbers and data,” said Eric Carlson, an attorney at the National Senior Citizens Law Center and head of its long-term care project.

“It’s easier to rate cars and phones because you’re looking at a product that comes out of the factory a certain way,” he said. “In nursing homes, there’s a lot more day-to-day variability.”

While the ratings are based on objective and unannounced inspections, they also draw on staffing and quality figures that are reported by the homes themselves and are not independently verified.

Carlson encourages people to visit prospective homes and ask tough questions, like whether the family can be involved in developing the resident’s care plan. By federal law, they have that right — but barely 1 in 10 residents know that, and only 2 in 10 homes comply with all the residents’ legal rights, he said.

In some situations, the star-rating systems can be useful, even vital, said Jack Halpern, a former nursing home administrator and now a advocate for quality.

“If a relative or a loved one is in a hospital and they have to make a quick choice — and 9 out of 10 times that is what happens — your family has more of a measure than they had before.”

Hospital discharge nurses, under pressure to open up beds, will direct patients to any nursing home with available slots — often homes with substandard records, he said.

But even a quick visit can tell someone a lot about a home. Halpern said you simply need to use and trust your senses, from the minute you walk in the door:

• Do security personnel look professional? Halpern tells of a time a guard, without looking up, told him to “sign the book.” He signed “Mickey Mouse” and walked past.

• Are a lot of residents hanging out in the lobby? That may be because the home does not offer enough activities.

• Are residents clean or dirty? Is there a smell of urine? Is it strong and pervasive, or limited to a certain area?

• Do you hear a lot of yelling or screaming? It may be a sign that too few staff can respond to calls for assistance. Are staff members talking to residents, or talking among themselves about their weekend plans?

• Visit the dining area. Does the food look and smell appetizing? Are residents eating, or are many full trays going back to the kitchen? That may be a sign of having too few staff to assist residents with eating.

Halpern is starting a campaign to get hospitals to inform people about the rating system, and to not refer people to homes with only one or two stars, though he knows that is not enough. 

“Nothing can substitute for paying a visit to the home,” he said.

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