Know Before You Go: Nursing Home Certifications

Written by Jeff Meyer on August 5, 2015

Know Before You Go: Nursing Home Certifications

Whether you agree with it or not, the Affordable Care Act is causing some major changes in the world of healthcare. And one area where many people remain unaware of the sweeping changes it caused is long-term nursing home care.

As part of the ACA, there have come demands for improvements in the ways that nursing homes are operated, and many will jump to meet these demands if they want to continue to receive their Medicare and Medicaid funding. From plans to improve training and quality of food, to reducing risks for infection or re-hospitalization the standards are slated to be radically improved.

For now, though, there are “minimum standards as a condition of Medicare and Medicaid payment,” and though many serious concerns have been raised over the years, particularly in the areas of quality of care and “oversight and enforcement” problems persist.

A May 2015 report from the Henry J. Kaiser Family Foundation (KFF) stated that there have been many “reports of quality problems in nursing homes persist, such as low staffing levels, new pressure ulcers (bedsores), and documented fire hazards. These are serious issues given the frailty and vulnerability of nursing home residents.”  (KFF.org)

Because of these concerns, the Nursing Home Compare tool from Medicare allows people to seek out a location by name, state, zip code, or city as well as the facility’s name. It allows visitors to compare detailed information about every certified facility in the entire country and even compare them against one another.

What Is Compared?

Of course, you may rightfully wonder just what it is that is being compared or described on the site. Fortunately, both Medicare and Medicaid services follow a “Five-Star Quality Rating System” that uses a specific methodology to accurately indicate the quality of care that can be anticipated in any site.

However, the groups have recently noted that they are “planning future steps to increase the star ratings’ reliability, as required by certain provisions in The Affordable Care Act (ACA) and the Improving Medicare Post-Acute Care Transformation Act (IMPACT).” (KFF.org)

Though these star ratings are entirely trustworthy, and for the most part, generated from objective data and facts, there are some self-reporting elements that can provide a skewed or artificially enhanced rating. In fact, recent findings by the KFF determined several disappointing details about the star-rating system:

• Facilities with large numbers of low-income residents tend to also have fewer stars or lower ratings in general.
• 40% of facilities in 11 states have only 1 or 2 (out of 5 possible) stars.
• Self-reported measures tend to have higher ratings than those derived from official state inspections.
• Non-profit facilities tend to rate higher than for profit sites.
• Sites with fewer beds usually have higher ratings than larger sites.

With groups like the KFF digging into the data and uncovering the realities of nursing home ratings, it pays for you to do some research using the same tools – the comparison tool through the Medicare website.

It is also helpful to understand that those ratings currently come from three data points: state health inspections, staffing ratios, and quality measures. The staffing ratios and quality measures are factors that involve the nursing homes themselves, and as such they can be more favorable than truly accurate. Though that sounds skeptical, it is a wise idea to use a bit of skepticism in light of the findings from organizations like KFF and the upcoming changes being recommended through the ACA and IMPACT.

Use the information you have available to you when making your choices in nursing care. It is up to you to uncover the facts and allow them to steer you in the right direction. If you discover a loved one is suffering from poor care or neglect, contact an attorney for help.

Sources

KFF.org. Reading the Stars… http://kff.org/medicare/issue-brief/reading-the-stars-nursing-home-quality-star-ratings-nationally-and-by-state/

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