National system rates
nursing home quality

Consumers will soon have easy
access to a uniform set of criteria

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Star-Bulletin staff and news reports

The federal government wants to make it just as easy for people to pick a nursing home as it is to find a good restaurant or a reliable car.

The Centers for Medicare & Medicaid Services released a new ratings system yesterday for nursing homes in six pilot states. The project is expected to go nationwide by fall.

"We're empowering consumers with information on how to get the best care possible for their loved ones," said Health and Human Services Secretary Tommy Thompson.

The new ratings are based on information from quarterly questionnaires that nursing homes must answer about their patients in order to receive Medicare payments.

The ratings are based on nine criteria, six for long-term patients and three for short-term patients in rehabilitation.

Long-term criteria include the percentage of patients who have bedsores, suffer from certain types of infection, have lost too much weight, need help with daily activities such as bathing or eating, suffer from severe pain and are placed in physical restraints.

Short-term criteria include the percentage of patients who show symptoms of delirium, suffer from very bad pain and have improved walking ability.

The rates in each category are then compared to the state average and the total average of other states. The six pilot states are Colorado, Florida, Maryland, Ohio, Rhode Island and Washington.

In the coming months, the agency is expected to add additional information on staffing rates and consumer complaints at individual homes.

A Web site (www.medicare.gov/NHCompare/home.asp) is maintained that will make it easier for harried consumers to compare nursing homes quickly, said John G. McDermott, Hawaii's long-term care ombudsman.

"There's information out there, but if you don't have a medical background, you might find it hard to interpret," said McDermott, whose job is to act as an advocate for those in nursing or other care homes.

The information on the new Web site is designed to be easily understood, he said.

Nothing substitutes for visiting a nursing home prior to choosing one, McDermott said, but by checking the Web site, a consumer might be able to find one or two that would be at the top of their list, or eliminate others. Most patients go to nursing homes from the hospital, he said, and relatives have very little time to make a decision.

"You're desperate: 'What am I supposed to do?'" McDermott said. "This Web site might be a faster way of doing it."

In addition, he said, families of patients in nursing homes can monitor conditions more easily with the Web site, he said.

That kind of information on the Web site is useful but not complete, said Helen Yoshimi, chief of the Hawaii Office of Health Care Assurance.

"It would be some of the things" to look at, Yoshimi said. "That's not all of the things you should look at."

Nursing home inspections performed by the state's Office of Health Care Assurance already incorporate more comprehensive data, she said. The inspection reports are public information and are available either from the office or from individual nursing homes.

The office also publishes a directory of the more than 40 nursing homes in the state, including information such as number of beds and staff size.

The office's reports include not only whether nursing homes passed or failed on specific criteria, but also inspector's comments and a statement from the nursing home about how any deficiency will be corrected.

"Definitely, we focus on the quality of care and also on the safety factors," Yoshimi said.

Federal officials point out that the ratings are different from similar data already offered through the Centers for Medicare & Medicaid because the percentages in each category are adjusted to compare nursing homes on an equal level.

Using quantifiable data to create level inspections is important to keeping subjective opinions out of the ratings process, said Richard E. Meiers, president and chief executive of the Healthcare Association of Hawaii, which represents two-thirds of the state's long-term care facilities.

"They're now going to base a lot of the opinions on the outcomes of data," Meiers said. "You're going to get a much more objective report."

Reports from inspectors are naturally subjective since they involve judgment calls by human beings, Meiers said. By using the same measures nationwide, nursing homes can be compared from location to location and across state lines, he said.

"It's going to be quantifiable data, and it will be pretty consistent across the country," he said.