Medicare's five-star system: New ratings method gets mixed reaction among area nursing home administrators

Saturday, January 10, 2009
Mary Mitchel, left, helps Agnes Leible find a bingo spot Wednesday afternoon at Fountainbleau Lodge in Cape Girardeau. Bingo is one of many activities the retirement community offers throughout the week for the residents.

A new five-star rating system of nursing homes by Medicare is drawing mixed reaction by administrators in Southeast Missouri.

Released Dec. 18, the new system rated 15,800 nursing homes that participate in Medicare or Medicaid. While Medicare has maintained a website designed to help consumers choose a nursing home since 1998, the newest ratings are designed to provide an easy means of assessing information already posted, according to Julie Brookhart, public affairs specialist for the Centers for Medicare and Medicaid Services office in Kansas City, Mo.

Throughout the years, the website has evolved, adding information on quality measures, survey results and basic information about nursing homes. The newest ratings on the Nursing Home Compare section of are based on an algorithm that calculates a composite view of nursing homes based on three measures: health inspection results, nurse staffing data and quality measures such as whether residents have gotten their flu shots, are in pain or are losing weight. Brookhart said the ratings add a new dimension to the site, which averages more than 3 million users annually.

"The overarching goal of the new rating system on Nursing Home Compare and all quality initiatives is to provide unbiased information for the public on key measures surrounding quality of care," Brookhart said. "Through public reporting and increased awareness by consumers, facilities will continue to advance the quality of the care they provide, resulting in better health-care outcomes for all."

Among the 16 nursing homes rated in Bollinger, Cape Girardeau, Perry and Scott counties, one scored five stars, four received four stars, four had three stars, three received two stars and four scored one star. Users can select up to three of those nursing homes to compare on the site.

Glenda Cato, administrator of Heartland Care and Rehabilitation Center in Cape Girardeau, was ecstatic that her facility was the lone recipient of a five-star rating.

"I felt like the whole nursing home should really pat themselves on the back for all their hard work," Cato said. "But it's nothing you should take for granted. You have to work at it this daily."

She cited communication among staff members through daily meetings and various committees as a reason for their success.

"My staff loves the challenge of making the residents and situation better," Cato said. "This is a total team effort.

"The staff and residents are their family," she said. "They care for one another and that's quite unique."

While administrator Dave Walker was pleased with Jackson Manor Nursing Home's four-star rating, he said the system is misleading to the consumer.

He said Jackson Manor Nursing Home was rated in a two-week period when more staff memebers than usual were on vacation, resulting in two out of five stars in the staffing category.

"It's not representative of what happens 365 days a year," Walker said. "We were downgraded in a category that we usually are strong in. This is just a snapshot of our entire operations throughout the year.

"The ratings are unfair to the consumers," he said. "They need to make their decisions on much more than a rating."

Mike Ratliff of Ratliff Care Center in Cape Girardeau agrees.

Though his home received a four-star rating as well, Ratliff believes consumers should visit different nursing homes before making a final decision. He encouraged consumers to gather information from other sources, such as references from friends, family and professionals in the industry.

"It's important to go and see what goes on in that home," Ratliff said. "The saying 'a picture is worth a thousand words' holds true in a nursing home.

"It's a better evaluation than what's just on paper," he said. "I can say that in light of the fact we have a good rating."

Other homes receiving the four-star rating were Jackson Manor, Fountainbleau Lodge and Elder Care of Marble Hill.

Marla Baughman, administrator of Perry Oaks Nursing and Rehabilitation Center in Perryville, Mo., said the facility's one-star rating did not reflect the level of care the facility provides. When surveyors rated them on the particular day, she said they were severely penalized for having a generator that wasn't working properly. Baughman said the piece of equipment had been vandalized, but it still significantly hurt their overall rating.

"We were penalized on something we had no control over," Baughman said. "To me the ratings aren't indicative of what the total care we and other nursing homes offer.

"We came out as below average. but we do an excellent job, as we don't have a lot of people losing weight or have sores," she said. "Sure, we have issues at times, but I don't think we're below average."

Baughman said the five-star ratings system only gives generalities and isn't specific like a survey conducted by the Missouri Department of Health and Senior Services.

"People can ask to see our survey, which gives specifics on what we were penalized for," Baughman said. "Come in and look at it. I don't have anything to hide."

Brookhart, the public affairs specialist, said the ratings are only a first step for any family considering placing a loved one in a nursing facility. In addition to the ratings, the Nursing Home Compare website provides other resources such as information on nursing home accreditation, a checklist for comparing nursing homes and a list of patient rights.

She said the ratings should only be used as a guide — not a substitute — for talking with physicians and visiting nursing homes.

"Use Nursing Homes Compare to start a conversation with your health-care professionals with your health-care professionals, friends and family about the quality of care that local nursing homes provide for particular health conditions, mobility issues and activity levels," Brookhart said. "We also hope families searching for the right nursing home will investigate home- and community-based alternatives to institutional care, for those who may not need a nursing home. Nursing Home Compare provides a link to these home- and community-based resources as well."


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