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Bill Would Require California Nursing Homes To Post Ratings

Two state Assembly members from Southern California have introduced a bill to require California nursing homes to publicly post the ratings they receive through a federal five-star system.

AB 215, by Assembly members Mike Feuer (D-Los Angeles) and Cameron Smyth (R-Santa Clarita), follows a similar effort by Los Angeles County supervisors who voted unanimously last month to urge Gov. Arnold Schwarzenegger (R) and state Department of Public Health officials to require nursing homes that receive Medicare and Medi-Cal money to publicly display star ratings and include the rankings in paperwork involving admission of new patients.

“For 20 years I’ve been working to make it easier for nursing home residents and their families to have easy-to-understand, readily available information about nursing homes,” Feuer said. “It’s such a difficult, emotional time for most people and yet the decisions can literally be life or death. The more information people have, the better.”

“The five-start system isn’t perfect, but it’s a start,” Feuer said.

New Federal System Revives Old Idea

In 2007, the state legislature passed a bill authored by Feuer to create an online rating system and repository of information about California nursing homes. The governor vetoed the bill, citing costs.

Two months ago, in an effort to make the vast amount of data it collects and stores more consumer friendly, CMS launched a new online rating system assigning one to five stars to nursing homes that receive federal money — virtually all nursing homes in the country. The ratings are based on state inspection reports, staffing levels and quality measures.

Some nursing home operators and trade groups say the rating system is flawed. Feuer and California nursing home patient advocates don’t disagree, but they say it’s the only comparative system available and it’s better than nothing.

“We have quite a few concerns about the federal rating system,” said Mike Connor, spokesperson for California Advocates for Nursing Home Reform, “but we still support this bill. It’s our view that nursing home residents, their family members and visitors ought to know about the ratings.”

“Typically, nursing home residents don’t have access to the Internet so this bill would help get the information in a place where they could see it,” Connors said.

Feuer is not expecting much opposition to AB 215, nor does he expect Gov. Schwarzenegger to veto it. The bill is “revenue neutral,” meaning it won’t cost the state anything to enact the law.

If AB 215 passes the Legislature and is signed into law, California could be the first state in the nation to require nursing homes to post their ratings, according to the American Health Care Association, a national trade group representing more than 10,000 nursing homes across the country.

Feuer’s Roots in Patient Advocacy

“This is an area of longtime interest for me,” Feuer said. “I ran a public interest law firm for many years and advocacy for nursing home residents and their families was a big part of what we did.”

Feuer ran Bet Tzedek, which began as a one-night-a-week legal aid office staffed by volunteers in Los Angeles in the early 1970s.  Bet Tzedek — Hebrew for “house of justice” — now has more than 30 senior centers through Los Angeles County, a staff of 55 and more than 400 volunteers.

Feuer said arming consumers with as much information as possible is the main goal of AB 215.

“This information should be among the factors that families take into account,” Feuer said about the five-star ranking system. “The federal system is a good starting point. I don’t think anybody should rely on any one system, including this one,” Feuer said.

Cameron Smyth — co-author of AB 215 who represents part of Los Angeles, Glendale, Santa Clarita and Simi Valley — said the five-star system simplifies a vast amount of data, making judgments easier for patients and families.

“The amount of information available to those who are seeking long-term care can be overwhelming to the average consumer,” Smyth said. “It’s important that we take steps to eliminate unnecessary confusion in an already difficult and emotional process,” he added.

Restaurant Grades Showed Results

In addition to providing a comparison tool for consumers, state and federal officials contend that publicly posting ratings serves as a motivator for businesses to improve their performance.

Posting restaurant grades in Los Angeles several years ago helped improve sanitary and health conditions, according to researchers.

In 1998, the Los Angeles Department of Health Services began requiring city restaurants to display a letter-grade card — A, B or C — corresponding to the result of their most recent hygiene inspection. According to research published by the American Agricultural Economics Association, the public posting of grades resulted in a reduction in food-related illnesses and improved hygiene inspection grades.

Health officials hope the same thing will happen with nursing homes.

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