Sorting out separate rating systems for elderly care

Older and disabled people in nursing homes and assisted living centers are especially vulnerable to lapses in care -- in many cases they lack the physical or mental capacity to speak up or walk out if things go wrong.

That's one reason both the federal and state governments have new rating systems for residential long-term care centers. But the separate systems -- one for more medically oriented nursing homes and one for assisted living centers -- are likely to cause confusion as they get under way.

"There's going to be huge confusion because of the five-star system of the nursing homes," said Jerry Cooper, executive director of the N.C. Assisted Living Association, a trade organization.

North Carolina's four-star rating system for adult-care homes goes into effect this month.

Meanwhile, the federal government's five-star system has already given ratings to all the state's nursing homes as part of a nationwide review.

WHY ARE THERE TWO SYSTEMS, AND HOW DO THEY DIFFER?

Adult-care homes, regulated under state law, are assisted living centers, rest homes and the smaller family care homes -- all designed to offer supervised residential settings for elderly or disabled people who don't need the higher level of care called skilled nursing.

Legislators voted the four-star system into law in 2007. To get the top rating of four stars, a home must get a score of 100 for two consecutive years. As a result, no home will get that rating during 2009.

Points are awarded for features such as sprinklers and generators, crucial in case of fires or power failures. Points are taken away for serious violations such as allowing a resident with dementia to wander off.

Nursing homes, for people who need skilled medical care, are regulated by the federal government.

Their federal five-star system, revealed two weeks ago, grades nursing homes from "much below average" to "much above average" according to staffing levels, quality measures and three years of health inspections.

WHEN AND WHERE CAN I SEE THESE RATINGS?

The federal nursing home ratings are available now at www.medicare.gov/spotlights.asp#NHC5.

State certification inspections used to calculate the grades for adult-care homes will begin this month, with ratings to follow within a few weeks. By the end of the year, every adult-care home in the state should be rated.

The adult-care home ratings will be available on the Web from the Division of Health Service Regulation at www.ncdhhs.gov/dhsr/.

In addition, each facility will be required to let consumers see both the rating and the worksheet used to calculate the grade.

WHAT ARE SOME OF THE PROS AND CONS OF THE RANKINGS SYSTEM?

The long-term care industry say the state's four-star system will unfairly harm smaller, mostly Medicaid-backed homes and will create a two-tier system of care in the state.

Advocates for the system have said North Carolina residents shopping for assisted living centers should have an easier time getting useful information about the history and quality of homes.

"It doesn't take the place of visiting facilities and otherwise doing homework," said Mary Bethel, a state AARP staffer."It does offer a comparison from one facility to another."