Nursing homes in state rated low

Trade group says survey is flawed

More than one in four North Carolina nursing homes will be judged "much below average" under a federal consumer rating system that debuts today.

High levels of staff turnover, along with patients' bedsores, excessive restraints, lost mobility and unrelieved pain are among indicators to be reflected in the five-star quality ratings from the federal Centers for Medicare and Medicaid Services. The ratings for individual homes were to be released this morning.

Preliminary figures circulating among state officials show that 119 of North Carolina's 419 nursing homes will receive one-star ratings -- much below average -- while 68, or 16 percent, will receive two stars, below average.

"It's awful -- clearly we need to focus attention on improving things," said Joan Pellettier, executive director of the Triangle J Area Agency on Aging. The organization oversees long-term care ombudsmen, who respond to consumers' and residents' complaints in a seven-county area.

"We generally hear statements about there being tremendous staff turnover in nursing homes," Pellettier said.

The ratings will appear on Medicare's online information service, which until now has not offered overall assessments of homes and has drawn consumer complaints for being difficult to interpret. In addition to the composite one- to five-star ratings, the site will judge each home on health inspections, quality measures and staffing levels.

The new system is designed to offer consumers an easier assessment of overall quality in nursing homes. But even before today's debut, the new system drew a fierce attack from the long-term care trade group for being "ham-handedly rolled out."

'Flawed and inadequate'

"It is based on significantly flawed and inadequate information that has stacked the public relations deck against nursing homes," William L. Minnix Jr., president of the Washington-based American Association of Homes and Services for the Aging, said in e-mail to members of the trade organization Wednesday.

Representatives of the N.C. Health Care Facilities Association, a state nursing-home trade organization, did not return calls Wednesday. National trade groups said the Centers for Medicare and Medicaid Services is being too hasty in starting a ratings system in which any errors could have harsh impacts on homes with low ratings.

"If there are errors, we would hope that CMS [the Centers for Medicare and Medicaid Services] would be quick to rectify them," said Jeff Horton, head of the state Division of Health Services Regulation, which oversees hospitals, long-term care centers and other health-related facilities.

The state's inspections of nursing homes, which it does for the federal agency, make up about half the information used for the new ratings, Horton said; the rest come from data federal officials require nursing homes to report. But Horton and other people familiar with long-term care in North Carolina said consumers shouldn't rely solely on a rating system; in-person visits by families might be more important.

"I would say it's one bit of information that people can use," Horton said, "but we recommend that people visit homes to get a feel for the quality of care."

Next month North Carolina will start its own five-star rating system for adult-care homes -- assisted living centers, rest homes and group homes that offer a lower level of medical care than nursing homes. The adult-care home system faced strong industry opposition in the General Assembly before passing with the support of AARP and other advocacy groups.