Column: Which nursing homes make the grade?
WASHINGTON -- When families need to make decisions about long-term care, many feel overwhelmed and unprepared. In addition to the significant financial burden, a number of factors weigh heavily on their hearts and minds when around-the-clock care...
WASHINGTON - When families need to make decisions about long-term care, many feel overwhelmed and unprepared. In addition to the significant financial burden, a number of factors weigh heavily on their hearts and minds when around-the-clock care in a nursing home is needed for a disabled or elderly family member.
A primary consideration is often location. Frequent, even daily, visits are a priority for some. Others need to navigate long-term care for a loved one from out of state. In addition to the patient’s doctor, advocacy organizations, personal referrals and state ombudsman programs can provide guidance on the quality of care and services available at nursing homes.
Families also can check an online tool maintained by the federal government. Medicare ranks the nation’s 15,000 nursing homes that are certified by Medicare and Medicaid on its Nursing Home Compare website. Consumers may research facilities at www.medicare.gov/nursinghomecompare . The federal agency scores nursing homes using one to five stars based on three criteria: health inspections; quality measures; and staffing.
During my tenure as chairman of the Senate Aging Committee, I scrutinized enforcement of federal health and safety standards to make sure nursing homes were measuring up to the standards of quality care for which residents and the taxpaying public were paying. Congressional hearings I led in 1998 profiled despicable cases of neglect and substandard care that were exposed by investigative federal audits. This led to reforms to help improve measurable standards of quality care and to strengthen the survey and certification process administered by the federal Centers for Medicare and Medicaid Services (CMS) and the states.
The Nursing Home Compare website serves double duty as a convenient tool for consumers and as a compliance incentive for nursing homes to achieve quality ratings. Along the way, I’ve pressured CMS to ensure the ratings system isn’t whitewashed so that consumers can trust the information as a true reflection of the care provided. Ineffective oversight and flawed certification measurements undermine the effort to improve nursing home safety and quality care.
I’m former chairman and now a senior member of the Senate Finance Committee. This panel has jurisdiction over the Medicare and Medicaid programs for which the public foots a $70 billion annual tab to pay for nursing home care. From here I advance efforts to improve quality of care standards, compliance and enforcement. For example, I’ve called upon federal auditors to analyze health and safety violations in facilities owned and operated by private investment groups and raised questions about the misuse of anti-psychotic prescriptions for nursing home residents. A 2011 federal audit showed that more than half of the 1.4 million claims for atypical antipsychotic drugs prescribed to nursing home residents failed to comply with Medicare reimbursement criteria. And despite the FDA’s issuing “black box” warnings, citing increased risk of death when these drugs are used to treat elderly patients with dementia, the prevalent use of these powerful drugs in our nation’s nursing homes calls for better transparency.
CMS recently revised its grading system to strengthen the criteria necessary to earn a five-star rating. Changes I welcome include a metric on the use of anti-psychotic medications in nursing homes. And by the end of next year, staffing ratios will be reported quarterly via an electronic system that can be crosschecked with payroll data.
Throughout my years conducting congressional oversight, I’ve found time and again that transparency is the public’s best warranty to improve public services and thwart wrongdoing.
That’s why I work for more openness in government, such as opening up federal courts to cameras; enacting the provision I co-wrote to create Medicare’s Open Payments database to allow patients to track financial ties between medical companies and health care providers; strengthening the Freedom of Information Act; and making Nursing Home Compare data more meaningful for consumers.
Making data transparency reliable, user-friendly and meaningful are good steps toward good government.
As a society, our aging demographics reflect just how important long-term care facilities will become with each passing year in the 21st century. In communities across the country, nursing homes serve as a home away from home for the frail and elderly who are no longer able to care for themselves.
Providing meaningful information that empowers consumers to compare and contrast verifiable benchmarks of quality care, from staffing ratios to anti-psychotic medications, will reinforce the public’s right to know and give greater peace of mind to those searching for long-term care options for their loved ones.