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U.S. Rates Nursing Homes In Quest To Improve Care

Nov 13, 2002 | The Oregonian's The federal government unveiled quality ratings of the nation's nursing homes Tuesday as part of a larger effort to push the facilities to take better care of their residents.

The Centers for Medicare & Medicaid Services for the first time published quality measurements for every federally regulated nursing home in the country, including 144 facilities in Oregon and 268 in Washington. The data, available online or through a toll-free number, include such information as the percentage of a nursing home's residents who had pain or bed sores.

"One of the toughest decisions facing individuals is where they're going to put their mother, grandmother, spouse," said Department of Health and Human Services Secretary Tommy Thompson. "We want to make sure those individuals will have the best information to make that decision and to get the best care."

In a rare display of collaboration, the government initiative is backed by the nursing home industry, the union representing nurses and nurses aides, and consumer advocates.

The national roll-out of the Nursing Home Quality Initiative follows a General Accounting Office report in March documenting abuse and neglect in many nursing homes and inadequate efforts by nursing homes to protect residents.

The federal government has increased its scrutiny of nursing homes as instances of abuse have come to light and as the cost of nursing home care rose from $53 billion in 1990 to $92 billion in 2000. More than 80 percent of the bills is paid by the federal Medicaid and Medicare insurance programs.

Families play key role Sen. Ron Wyden, D-Ore., who has worked on issues affecting senior citizens, said passing "laws by the crateful" to improve nursing homes doesn't work "unless you were able to get family and friends involved. The key to doing that is getting the information that empowers them to know what to ask and what to look for."

Advocates for older adults and people with disabilities called the government's effort a first step in the right direction, but they questioned whether the data may be difficult for the public to grasp.

"It remains to be seen ultimately how helpful this information will be to the individual consumer," said Meredith Cote, the long-term care ombudsman for Oregon.

Oregon nursing homes, on average, did worse than the national average in six of the nine quality measurements for which both averages were calculated. Most showed a few percentage points difference.

The exception was that 41 percent of residents in Oregon nursing homes for 14 days or fewer reported pain in the previous week. The national average for so-called "short-stay residents" is 25 percent. Pain among residents in an Oregon nursing home for more than 14 days -- the majority of residents -- was 12 percent similar to the national average of 11 percent.

Washington nursing homes mirrored Oregon, rating worse than the national average in six of the nine areas with the most dramatic difference in the area of pain for short-stay residents. In Washington, 35 percent of short-stay residents reported pain. The percentage in pain among longer term residents was the same as the national average.

Nursing home industry leaders helped the government devise the measures. Many said it is one tool for evaluating a nursing home and is no substitute for visiting the home. They also said that the pain measurement shows how the data can be misunderstood.

Most short-stay residents come from a hospital after surgery or stroke and are likely to have pain. They are treated with short-acting drugs so their pain often reappears. Oregon nursing homes try to get these short-stay residents on their feet and back home or to a less expensive care center more quickly than other states. That means more intensive physical therapy and that can sometimes mean more pain, said Margaret Murphy Carley, deputy director of the Oregon Health Care Association.

"That's a measurement of pain, not pain treatment. I think we're doing a better job of assessing pain and therefore we're going to have higher scores," Carley said.

The federal government did not attempt to rank nursing homes from best to worst, in part because of industry concerns about misinterpretation. But nursing home leaders said they get the message that accountability is the name of the game.

"We have a lot of work to do," said Larry Minnix, head of the American Health Care Association. "The good homes will shine. Many will see they need to get better and those who refuse to get better will be driven out of business, and that's the way it should be."

The federal government's initiative does not include assisted living centers, residential care facilities or adult foster care homes, other types of long-term care popular in Oregon. That's because the initiative is driven by where the government is spending Medicare dollars. Medicare, the health insurance program for senior citizens, pays for as many as 90 day-stays in nursing homes, the bulk of the nursing home trade.

The initiative is medically oriented rather than also looking at such quality of life issues as the social activities offered to residents. Rose Blauer, 88, and a resident at Robison Jewish Health Center in Southwest Portland, said activities make her happy.

"The music here is beautiful. I love it. I like the ceramics, and I paint," said Blauer, who added that she also enjoys exercising. She pulled up her sleeve to show that though frail, she can still flex her bicep.

The initiative will be used by local organizations that are contracted by the government to work to improve nursing home care.

The measurements, however, do not address a critical need by nursing homes for more and better trained staff. But Wyden and others think it could lead to that.

"This survey really is going to expose how dire the staffing shortage is," Wyden said. If "people learn that having trained, able staff is essential, you can use the data to make the case for change."

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