"Critical on conditions: Satisfied staff called key to good care"
Third and final of three parts
PART I: Nursing home ratings reveal quality control at several local facilities (Jan. 17)
PART 2: Two nursing homes cited more than others (Jan. 18)
Chico Enterprise Record
By LARRY MITCHELL-Staff Writer
Posted: 01/17/2009 12:00:00 AM PST
OROVILLE -- What's the secret to providing good nursing-home care?
Having a contented, long-term staff that's familiar with the residents, said Ron Brown, administrator of Shadowbrook Health Care in Oroville.
And how do you find and keep such a staff?
Get them to offer ideas about improving care and listen to them, Brown said. Respect them.
Shadowbrook is one of two north-valley nursing homes that rated the highest in an informal survey the Enterprise-Record made of 16 facilities in the north valley.
The other top-ranking nursing home, Valley West in Williams, is owned by the same company that owns Shadowbrook, Riverside Health Care. (Although it's based in Chico, it has no connection to Riverside Convalescent Hospital). The company Brown works for owns nine nursing homes in Northern California.
The Enterprise-Record analyzed data from three Web sites that attempt to evaluate the quality of nursing homes. These consider such things as citations issued by the state, complaints by residents and their families, and various quality measures.
Among the 16 nursing homes in the north valley, the E-R found two that seemed to stand out (Shadowbrook and Valley West), about a dozen that were in a middle group, and two that were on the bottom end.
That breakdown seems to parallel the situation statewide, said Pat McGinnis, executive director of the nonprofit group California Advocates for Nursing Home Reform (CANHR).
Recently, Medicare produced a feature on its Web page that tries to make it easier for the public to compare quality of nursing homes. It uses a five-star system for rating the facilities.
Brown said he didn't put a lot of stock in such methods of rating nursing homes. Often, they don't give enough information to present an accurate picture, he said. For example, a facility might get a number of complaints about alleged abuse of patients. The state can investigate and find all of the complaints unfounded. But the nursing home still gets a high number of "abuse complaints" in its ratings, and the public gets worried when it sees that, he said.
Nevertheless, Brown didn't claim his facility's good report card was meaningless.
He said the chief factor in its good performance is the staff. There's been low turnover, he said, and some of the department heads have worked at the facility for many years.
For example, Karen Beeler, the director of nursing, started as a dishwasher when she was 16. Later, she left and became a nurse. She has worked at Shadowbrook for the last 23 years.
Sandi Baker, the administrator at Valley West Care Center in Williams, has been there 14 years.
Brown was asked if he thought Shadowbrook's relative smallness (it has 50 beds, where other facilities in the area have up to 100 or more) contributed to its good performance. He said it absolutely was a factor.
Every study shows that where the staff is very familiar with nursing-home residents, the outcomes are better, he said. And where the number of patients is smaller, it's more likely the staff will know the patients better.
Brown, who has worked in nursing homes since 1979, was asked if he thought conditions and the care provided has improved.
While he's personally seen instances of improvement, he said, overall things haven't gotten better.
And at present, the shortage of nurses represents a "a huge crisis," he said.
McGinnis, who heads CANHR, the watchdog group, has had a long career in the field, also. She has worked with CANHR since 1983 and was employed in nursing homes before that.
Some things have improved, she said. Because of changes in the law, residents have more rights now. They are more willing to speak up and make complaints and increasingly, nursing homes are the defendants in lawsuits — something that was rare years ago.
But the overall quality of care hasn't seemed to improve, she said. It certainly has not reached acceptable levels, she added.
There are problems with the state's system of inspecting facilities, and it's troubling that many times nursing home owners get out of paying the full amount of fines levied against them, she said.
But in her view, the biggest problem is that making a profit and providing residents with high-quality care don't mix, she said. Inevitably, there's not enough money to "provide good-quality care and pay off your investors."
McGinnis said she advises people to do all they can to keep loved ones out of nursing homes. If they have to place a relative in a home, they should choose very carefully, and once the person is living in a facility, his or her care must be monitored closely.
Many nursing assistants want to give good care, she said, but they can't because they have too many residents to attend to.
She said she worries about the situation a great deal. Nursing homes are inspected about once a year. But many, many old people live in smaller residential care homes, which are scrutinized much less closely. On average, they might be inspected once every five years, she said. "We don't know what's going on in these places."
Brown said nursing homes provide a great service to the community, mostly providing excellent, much-needed care.
Nevertheless, there seems to be wide agreement that many nursing homes need to do better.
In 2004, the Legislature passed, and Gov. Schwarzenegger signed, a bill designed to give nursing homes better reimbursement through Medi-Cal. Nearly 70 percent of California's nursing-home residents are on Medi-Cal.
Assembly Bill 1629, authored by former assemblyman Dario Frommer, a Los Angeles Democrat, changed the way nursing homes are reimbursed through Medi-Cal. Before, they were paid a flat rate per patient. Under the bill, they are supposed to be paid more for spending more on patient care, such as for investing in hiring more staff or adding new facilities.
The legislation also had the state's nursing homes pay a fee, which was used as matching funds that would bring in federal funds for nursing-home care.
Last year, a team from the University of California at San Francisco did a study to determine whether AB 1629 had improved care. It found little improvement.
Owners of nursing homes and others countered that it was really too soon to assess the effect of the legislation.
Another bill passed last year set up a "working group" of stakeholders who would study the situation and recommend how AB 1629 should be modified.
McGinnis didn't sound overly hopeful about prospects for favorable changes. California has never had a plan for long-term care, she said.