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Nursing home ratings clarification
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Kelly Parker
SMC Marketing Director
"I wanted to point out some information relevant to the article “Nursing home industry worries about new ratings” from the Dec. 19 edition of the Alva Review Courier and the Associated Press, written by Kevin Freking. There have been other stories run in the Oklahoman and other sources, but I’m not sure they hit the mark either. This has been sent to the Alva Review Courier."
First of all, Mr. Freking is generally correct in his overall assessment of the industry, that a number of nursing homes and nursing home organizations are quite concerned with these ratings which have been public information for at least two years now via the Internet. Many facilities and nursing home organizations have received poor ratings from a somewhat flawed rating system; that’s not to say however that the flaws in the system have been responsible for the low ratings. Instead, the flaws ultimately make it difficult to compare one facility to another. At any rate, the federal government has taken a step in the right direction by reporting this information, but as Mr. Freking suggests, more steps are needed to ensure appropriate ratings on a consistent basis.
The article also suggests that there has been discrimination in the ratings for only having used state inspections to rate facilities. The argument made by the Ohio CEO suggests that a resident’s happiness trumps health and safety, which are the primary foci of state inspections. And while resident happiness is certainly overlooked in the federal ratings, this argument loses its validity if residents should be expected to choose between their health and safety or their happiness. Happiness, health and safety are all equally important and a few quality facilities have worked very hard to provide all three.
Not mentioned in this Washington generated article was that there are a number of states, including Oklahoma, that have started rating resident and employee satisfaction, or happiness, along with the other quality indicators included in the Medicare ratings. For folks considering an Oklahoma facility, check out http://www.oknursinghomeratings.com/ to see in-state comparison ratings. Most would say that the Oklahoma ratings are a better, more consumer-friendly indicator of overall quality than the federal ratings. Both local nursing homes, Share and Beadles, rate well overall in both the state and federal systems.
Below is a list of the rating factors and their descriptions used to rate Oklahoma facilities.
| Quality of life | The state administered Resident / Family Satisfaction survey measures the extent to which the facility provides a pleasant, respectful and meaningful place for the resident to live. |
| Resident/Family satisfaction | The state administered Resident / Family Satisfaction survey measures the quality of nursing care, the quality of meals, laundry and the cleanliness and the overall satisfaction of families and residents with the quality of the facility. |
| Employee satisfaction | The state administered employee satisfaction survey measures the employees' satisfaction with the facility as a place to work and the extent to which the employees would recommend the facility as a place to receive care. Employee satisfaction in long-term care is integral to the overall quality of the care and service provided by that facility. |
| CNA/NA turnover and retention | CNA/NA turnover and retention is a measure of the stability of the nursing assistants (CNA / Certified Nursing Assistants) that care for residents in the facility. Turnover measures the percentage of positions that have turned over in the past year and retention is the percentage of the current nurse aides who have been employed by the facility for at least one year. Stability is directly related to the quality of care provided by the facility as stable, satisfied employees are more able to form relationships with the residents, understand their needs and understand the work practices of the facility. |
| Nurse turnover and retention | Nurse turnover and retention is a measure of the stability of the licensed nurses that care for residents in the facility. Turnover and retention of licensed nurses is measured the same as with CNA/NAs. |
| State survey compliance | Nursing facilities are regulated by the state Medicaid system. As part of that regulatory process, the facility is routinely subjected to a rigorous inspection process (the "state survey") to measure compliance with federal and state regulations. The state survey compliance is based on regulations that are directly related to the quality of nursing care provided by the facility. |
| System-wide culture change | Culture change describes the growing movement in long-term care that seeks to change the way care is delivered in nursing homes. The term "person centered care" is used to describe the extent to which the facility delivers care focused on the needs of the resident. This measures the extent to which the facility is able to deliver care efficiently and effectively, while focusing on resident choice and resident well being. |
| Clinical measures | The extent to which the facility is able to minimize the number of falls, prevent residents from needing catheterization, reduce physical restraints, provide for nutritional support, and prevent pressure sores is an indicator of the effectiveness of the nursing process practiced in the facility. |
| Occupancy | Occupancy is included in the Focus on Excellence program because research shows that occupancy is impacted by both consumer satisfaction and employee satisfaction. |
| Nursing staff per patient day | Staffing, along with other factors, is an indication of the quality of care in the facility. Staffing directly measures the resources that are available to provide care. Other measures must be considered along with staffing to provide a comprehensive understanding of overall quality. |
| Overall Star Rating | The overall rating is to tell which facilities consistently rate above average in all areas. Each facility gets a point for each of the ten rating factors that achieve above 4 or 5 stars.
Facilities with 1-2 points will receive 1 overall star
Facilities with 3-4 points will receive 2 overall stars
Facilities with 5-6 points will receive 3 overall stars
Facilities with 7-8 points will receive 4 overall stars
Facilities with 9-10 points will receive 5 overall stars
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In general, all information is good information when it comes to helping people make informed decisions regarding long-term care placement. Every home is different, so the chances of finding the right home are pretty good. Look at the ratings, but never make a decision such as this without first visiting facilities and meeting the people who live and work at them.
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