File image. Gannett News Service.
More than 560 of the nation's nursing homes have not budged for the past three years from a one-star federal government rating the lowest on a five-star scale even as most homes improved, according to a USA TODAY analysis of federal data.
DATABASE: NURSING HOME RATINGS FOR FLORIDA AND THE OTHER 49 STATES
In Georgia, more than one in 10 nursing homes have consistently received one star in the Centers for Medicare & Medicaid Services (CMS) rating. Pennsylvania and Louisiana each had 8% of homes at the lowest rating.
"Nobody wants to see consistent one-stars; they give everybody a bad name," says Larry Minnix, president and CEO of LeadingAge, an association of non-profit nursing homes. "You'd like to think the marketplace would deal with it and residents wouldn't get placed there, but sometimes they don't have a choice."
The lowest overall rating is awarded to homes "much below average" compared with others in their state, according to CMS. Among problems that can drop a rating: consistently dirty equipment and linens, mistreatment and unlicensed caregivers or specialists.
The star ratings are part of a broader federal effort to increase transparency for consumers of health care. When introduced in late 2008, nursing home industry groups called them simplistic and unfair. Some consumer advocates say nursing home quality can change quickly, and no ratings system is perfect.
"Nursing homes can plunge in quality overnight," says Janet Wells, director of public policy for The National Consumer Voice for Quality Long-Term Care. "It could be a change in the director of nursing or the administrator, or purchase by a chain with a bad track record. Nursing homes can also improve dramatically under a new manager or personnel."
The federal government contracts with states to inspect nursing homes about once a year. The star ratings combine scores of data points, including information from annual inspections, quality measures and staff time spent with residents.
Nursing Home Compare lists the most recent star ratings but doesn't provide a history for consumers. USA TODAY analyzed the ratings for 15,700 nursing homes for the past three years. Among the findings:
•Quality improved. The share of nursing homes receiving one or two stars overall fell to 35% in 2011 from 40% in 2009. At the same time, four- and five-star homes increased to 43% from 38% of nursing homes. The share of three-star homes remained steady.
•Some homes are stuck at the bottom: 564 homes representing 77,315 beds received one star in each of seven reporting periods analyzed over three years. But 448 homes received the best overall rating five stars during each period.
•Among the consistently low performers, almost two-thirds were for-profit nursing homes that are owned by chains. That's a higher share than the 40% of all nursing homes in for-profit chains.
The nation's largest chain by number of beds, HCR ManorCare, had 22 of its 277 nursing homes with consistent one-star ratings since 2008. None of its homes was a consistent five-star performer, the analysis found.
HCR officials declined to be interviewed but said in a statement that the ratings are often out-of-date and don't reflect the high proportion of patients with multiple ailments and complex care requirements. Its centers "treat more complex and post-acute patients than our competitors," the statement said.
Golden Living, the second-largest nursing home chain, had 11 nursing homes with consistent one-star ratings. It also had eight homes with five-star overall ratings for the past three years. The company's own analysis found the average star ratings improved each year across its 305 properties, spokesman Blair Jackson says.
A voluntary program helped one-star nursing homes in four states improve quality by lowering staff turnover, says Mary Jane Koren of the Commonwealth Fund, a health policy foundation. An industry-backed quality campaign worked with local nursing home regulators and health professionals to help 17 inner-city nursing homes.
"How do you keep those places open, but open and improving?" Koren says. "By stabilizing the staff, you begin to see improvements in clinical quality in areas like pressure ulcers and overuse of physical restraints that are used to stop falls and wandering."
Lower staff turnover can create better care because employees become familiar with the routines and needs of nursing home residents. That's the case at Bethany Health Care Center in Framingham, Mass. The facility has earned a five-star overall rating each year in part by having staff focus on quality of life.
"It's our practice to have certified nursing assistants (CNAs) assigned as a group to the same patients each day, and if they're out, they always have the same substitute," says Sister Jacquelyn McCarthy, CEO and administrator.
"Those CNAs know what time the resident likes to get up, how they like their coffee, the clothes they like to wear, when they like to take a shower. Those CNAs are the direct caregivers who bathe and groom them and get them ready for the day," McCarthy says.