Calif. Advocates Encouraged by Revisions to Nursing Home Ratings

Advocates in California and other states have largely applauded the federal government's revisions to how it will evaluate nursing homes as a good start to addressing discrepancies in self-reported data, the Center for Public Integrity reports (Lowenstein, Center for Public Integrity, 2/23).

Background

Medicare's Nursing Home Compare system is used to rate nursing home facilities. The best possible rating Medicare can give to a nursing home is five stars.

Under the adjusted ratings, the government expects facilities to earn a minimum of three stars of ratings related to staffing levels for registered nurses, licensed practical nurses and certified nursing assistants. Sufficient staffing in these areas is related to fewer medication errors and lower incidence of patient complications.

In addition, the ratings now will include quality measures about appropriate use of antipsychotic medications. Such medications often are given to elderly dementia patients.

Further, CMS said it will increase its use of on-site visits by state survey agencies as a way to assess the information the facilities report.

The changes make it harder for facilities to receive top scores (California Healthline, 2/17).

CANHR Reaction

In a release, California Advocates for Nursing Home Reform called CMS' updated evaluation methods a "welcome start" and the "first among several steps" toward aligning patients' experiences and inspection results.

CANHR Executive Director Patricia McGinnis said, "For too long, the CMS rating system for nursing homes has been inaccurate and misleading to consumers trying to find placement in a nursing home," noting that some nursing homes in "California and the rest of the country ... have inflated their nurse staffing hours and gamed resident data."

However, CANHR said that the federal government should further address the reliability of the compare system by:

• Improving the accuracy of staffing data;
• Improving enforcement of regulations;
• Ensuring quality and timely inspections and investigations into complaints; and
• Increasing citations and penalties for misusing antipsychotic drugs (CANHR release, 2/20).

Calif. Lawmaker Signs On to National Nursing Home Staffing Bill

In related news, Rep. Lucille Roybal-Allard (D-Calif.) has signed on as a co-sponsor of reintroduced legislation (HR 2187) that would increase the number of hours a registered nurse must be present at nursing homes, according to the Center for Public Integrity.

The bill would require nursing homes to bump up RN levels from eight hours to 24 hours per day (Center for Public Integrity, 2/23).