"Many see new nursing home scoring system as flawed"
By LORA HINES
10:00 PM PST on Thursday, December 18, 2008
More than half of the Inland's 105 nursing homes ranked "below average" or "much below average" based on a new quality system released Thursday by the federal agency that monitors care for the elderly, disabled and poor.
But at least two Riverside County facilities in Hemet and Palm Desert and one Fontana nursing home received "average" and "above average" ratings, even though they were fined by the California Department of Public Health during the past year following patient death investigations.
Nursing home industry and patient advocates as well as relatives of nursing home patients say such high ratings for those nursing homes show the Centers for Medicare & Medicaid Service's new five-star system is flawed.
"I am disgusted. I am appalled," said Joseph Baroncini, of Hemet, whose mother, Olga Baroncini died in 2007 while she was a patient at Hemet Valley Health Center.
The facility got a five-star rating, even though it was fined $100,000 following Olga Baroncini's death.
Earlier this year, administrators at Valley Healthcare Systems, which owns Hemet Valley Health Care Center, closed the nursing home because of financial issues.
David Sayen, Medicare & Medicaid's regional director in San Francisco, said the rating system does not factor disciplinary actions taken by state agencies, such as fines. Generally, he said, one nursing home death does not indicate a systemic problem.
Kerry Weems, acting administrator of Medicare & Medicaid, said nursing homes earn star ratings between one and five based on three categories: health inspections, quality indicators, such as bed sore reports, and staffing levels.
The more stars, the better the quality, according to Medicare & Medicaid.
"You can't do this perfectly," Sayen said, adding that Medicare & Medicaid chose to release the information it has, adding it will be updated monthly. The process will be tweaked as the agency includes other rating measures, such as consumer satisfaction surveys, he said.
Nursing home industry and patient advocates say the agency uses data that's up to three years old to develop its ratings. It also rates nursing homes based on incomplete data, according to its Web site.
"I think it's a tool like a lot of other tools that are out there," said Betsy Hite, spokeswoman for the California Association for Health Facilities, a professional organization for nursing home owners and operators. "I don't think it should be considered a reliable tool."
The ratings primarily are based on three year's worth of health inspections -- about half the rating is based on the most recent inspection, the rest on the older inspections.
Scores for the other two categories, quality indicators and staffing, enhance facility ratings, Sayen said. So, if a nursing home has no data for these categories, Medicare & Medicaid base that facility's rating solely on inspection scores, he said.
For example, Medicare & Medicaid gave Redlands Community Hospital's nursing home four stars based on inspections, even though the agency Web site indicates it didn't have information for quality indicators or staffing.
Hite said it's unfair to base ratings on old inspection information, especially those that formerly were poor performing nursing homes, which have new owners.
"These results are not going to show that change in ownership," Hite said. "This is an example of the government trying to simplify something very complex."
The rating system is not an alternative to visiting nursing homes to determine how well they care for patients, she said.
Sayen said nursing home owners who disagree with ratings may contact Medicare & Medicaid.
"Our real hope is that people will focus on quality improvement rather than meeting minimum standards," he said.
Medicare & Medicaid rated an estimated 15,800 nursing homes, including 53 in San Bernardino County and 52 in Riverside County. Of those facilities, 37 got one star, which the agency identifies as "much below average." Twenty-nine nursing homes received two stars, which means they are below average, according to Medicare & Medicaid.
Besides Hemet Valley Healthcare Center, The Springs at The Carlotta in Palm Desert received a three-star rating, even though it was fined $100,000 this year following a patient death investigation. Citrus Nursing Center in Fontana got a four-star rating despite a $100,000 fine it received in December 2007 following a patient death investigation.
"That's one of the major weaknesses of the whole system," said Mike Connors, spokesman for the consumer advocacy group California Advocates for Nursing Home Reform. "It doesn't take into regard any action that California has taken. The ratings are part of the picture."
He also said measures used to rank nursing home staffing are flawed because facilities self report that information. They don't have to verify it with copies of time cards or pay stubs, Connors said.
Despite its shortcomings, he said, the rating system shows California has many poor-performing nursing homes.
Connors said he is hopeful the information will become more reliable as Medicare & Medicaid's evaluation processes evolve.
"But the information is helpful only if it is sufficiently reliable," he said. "That's not necessarily the case here."
Elizabeth Plott Tyler, whose family owns five Inland nursing homes, said she was stunned by the ratings. Her family's facilities got one-, two- and four-star ratings.
"I thought we would come out a lot better," said Tyler, who added that her family's facilities almost always meet state standards. "We're failing this federal system?"
Nursing home ratings
Out of 105 Inland nursing homes, 66 scored below average.
Riverside County has 12 with one star and 14 with two stars.
San Bernardino County has 25 with one star and 15 with two stars.
Go to www.medicare.gov to see how Medicare & Medicaid rated facilities throughout the state and nation.