Consumer access to information improves nursing home care

About 35,000 fewer nursing home residents are kept in restraints on a daily basis -- down 23 percent from two years ago -- according to a federal report released Wednesday that also found fewer patients in pain.

The Ratliff Care Center of Cape Girardeau is one of four Missouri nursing homes who showed significant increases in quality of care, according to the report.

The Bush administration, the nursing home industry and patient advocates said the declines show the value of the administration's 2-year-old program to tackle serious quality problems in many homes, by requiring nursing homes to disclose data on care.

The information is posted to help consumers make better choices and to prompt the homes to improve their performance. It is available on the government's Web site, www.medicare.gov, or by calling (800) 633-4227.

"When we made these measurements public, then people paid attention," said John Rother, policy director for the 35-million member seniors' group AARP.

All the information is based on data the nursing homes must routinely collect from residents as part of their participation in the federal Medicare program.

About 1.6 million people live in nursing homes daily. During a year, more than 3 million people have a nursing home stay, the report from the federal Centers for Medicare and Medicaid Services said.

Patients kept in restraints can become weak, lose their ability to go to the bathroom on their own and develop bed sores.

According to Primaris, an agency that worked on the report, Ratliff, a family-owned 46-bed licensed nursing home, improved their residents' quality of life by cutting pressure ulcer rates by 86 percent.

Michael Ratliff, assistant administrator of the Ratliff Care Center, said the public's perception of pressure sores and restraints can be misleading.

Ratliff explained that a red mark on a patient's body is considered to be a pressure sore. Sometimes, he said, residents who come to the home from another facility or from their families have sores when they are admitted. Ratliff said that his company has invested "a lot of capital" in measures designed to alleviate sores.

In addition, he said, the nursing home bought gel-filled cushions that help alleviate pressure when a patient is sitting in a wheelchair or at the dining room table and also bought circulating air mattresses. The mattresses are divided into two chambers. One side deflates as the other side inflates every few minutes, thereby moving pressure points without moving the patient, Ratliff said.

The credit for the good results, Ratliff said, goes to the people who work for him.

"You can have the best process and the best policies, but if they are not effectively implemented they're not going to be any good. I have a good staff who have worked hard on implementing and following the new technologies we implemented."

Ratliff said the nurses and certified nurse assistants don't get enough credit for the work they do.

"Some of them could go elsewhere and make more money, but they're here because their heart directs them here," Ratliff said. "They care about these people."

Dr. Mark McClellan, the Medicare and Medicaid administrator, cited examples of homes in which residents are not restrained and few have bed sores. The 150-bed Eliza Jennings Home in Cleveland, which does not restrain patients as a matter of policy, showed an 84 percent drop in sores, he said.

"It matters which nursing home you choose," McClellan said.

The program started with 10 measures and has increased to 15. New entries include staffing levels and weight loss among long-term residents.

The government also is starting a trial program in seven states to conduct background checks on all prospective employees of long-term-care facilities who will have direct contact with patients. The states are: Alabama, Idaho, Michigan, Nevada, New Mexico, South Carolina and Wisconsin

Staff writer Linda Redeffer contributed to this report.

Despite recent industry improvements, congressional investigators in 2003 found that many nursing homes have serious quality problems. The General Accounting Office, since renamed the Government Accountability Office, also said state inspectors are failing to catch a large number of the problems.

About 3,500 nursing homes were cited for harming patients or placing them at risk of serious injury, the GAO said. The investigation covered mid-2000 through 2002.

Examples of negligent care include improperly stored medical equipment and patients with untreated bed sores.

Patient advocates have praised the availability of the information but have warned that consumers should not choose a home without visiting it, talking to residents and getting information from state offices that monitor long-term care facilities.

Staff writer Linda Redeffer contributed to this report.

On the Net

Medicare's Nursing Home Compare: www.medicare.gov/nhcompare/home.asp