Medicare survey rates the region's nursing homes

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February 18, 2009

By JEFF MEYERS The Press Republican Wed Feb 18, 2009, 06:51 AM EST

PLATTSBURGH -- A new nursing-home rating system available through the federal government's Medicare Web site allows consumers to compare facilities in a given area.

But those options are significantly weakened in the North Country, where nursing-home beds are at a minimum and waiting lists for beds continue to grow.

"Studies have shown that we're under served by 150 beds," said Rosemary Reif, nursing services director at CVPH Medical Center, which has 70 nursing-home beds and another 20 beds in its Transitional Care Unit (TCU) for patients planning to go home after hospital care.

"The lack of nursing-home beds in this county is unbelievable," added Kyle Cahill, interim administrator for the CVPH Skilled Nursing Facility. "If you go downstate, communities are over-bedded."

Bed shortages in Essex and Franklin counties compare with those in Clinton County, though the region is hoping for relief with the construction of a state-of-the-art facility in Plattsburgh that will provide more than 200 new beds.

That project's start date is at least several months away and could take until 2010 while officials await approval from the State Health Department begin construction.

Even then, more than 100 of those beds will be taken when the CVPH and Evergreen Valley nursing homes close when the new facility opens.

FIVE-STAR SYSTEM
Meanwhile, consumers can access a variety of information on each regional nursing home at the Medicare Web site, www.medicare.gov.

The site offers comparison ratings in such areas as health inspections, nursing-home staffing and quality measures, which is information collected by nursing homes on residents' health, physical functioning, mental status and general well being.

"It's a rating system that was developed with the intent of helping consumers become well informed," said Paul Richards, administrator of Meadowbrook Health Care in Plattsburgh.

"We support a rating system," he added. "However, there are elements to this system that we believe are flawed. Different providers serve different types of patients, and that makes it difficult to determine whether the differences in ratings are due to quality."

For instance, Meadowbrook Healthcare offers rehabilitation services for patients who have been discharged from the hospital but are not quite ready to go home. Those patients often have to deal with pain, which is recorded in a facility's quality measures.

"Quality measures are largely determined by the type of resident admitted," Richards emphasized.

In the five-star rating system, in which one star represents the weakest level and five starts the strongest, Meadowbrook consistently shows three out of five stars across the board, including three stars for its overall rating.

"That's an average rating, and we're not happy with it," Richards said. "We definitely believe we are a four- or five-star facility, and we're working hard to prove that we've earned a higher rating."

He did say that the rating system does do a good job in identifying the strongest and weakest nursing homes overall but feels that are too many other factors that impact the middle ratings.

"If you look at our latest resident-satisfaction and family-satisfaction surveys, you'll see that 93 percent of our families and residents would recommend us to others," he said.

VISIT THE FACILITY
CVPH Medical Center's Transitional Care Unit, one of five demonstration projects in the state for this type of in-hospital service, received four out of five stars for its overall rating and would have gotten a top-notch score if not for scoring one star in quality measures.

"It's a data thing," Reif said. "The length of stay for patients in the TCU is five to 20 days, so we don't have enough data collected to provide sufficient information for quality measures."

The hospital's nursing home received five stars for its staffing but lost considerably for its health inspections following an incident last year when a resident wandered from the unit, which had to be reported to the Health Department.

"The state came in and after their review made several recommendations," Cahill said. "We worked with the state on those recommendations and just had another survey two weeks ago that went very well."

That inspection may go a long way toward improving the next Medicare ratings, which now show two out of five overall, but the current ratings will not be adjusted throughout the year.

Clinton County Nursing Home was one of the top-rated facilities in the entire region, earning a four-out-of-five-star overall rating.

"We're very blessed and fortunate to receive four stars," said Administrator Wendie Bishop. "It's exciting for me to think that our staff are such compassionate and caring individuals who come to work every day with the intent to improve our residents' lives."

Bishop also believes the rating system has some flaws -- particularly in the use of state surveys that do not adjust to the unique needs of individuals in each nursing home -- and should be used in conjunction with other methods of determining a nursing home's effectiveness.

"If you have an opportunity to visit a facility, that's the best way to develop a comfort level with what's going on there," she said. "See what kinds of activities are offered, how well residents interact with staff."

E-mail Jeff Meyers at: jmeyers@pressrepublican.com