November 5, 2009
By Hillary Copsey
Treasure Coast nursing homes, over all, don’t compare favorably to those in other Florida counties, according to a Scripps Howard News Service analysis of national data.
The average rating on the Centers for Medicare and Medicaid Services’ Nursing Home Compare system for St. Lucie County’s nine nursing facilities is 2.33 stars out of five, lower than all but seven other counties with nursing homes. Indian River County’s average 2.4 star rating puts it ahead of St. Lucie and just three other counties, while Martin County’s 3.29 star average leaves it solidly in the middle of the pack.
But at least one nursing home in each Treasure Coast county has earned top ratings in the system, which began late last year.
And, though the federal rating system takes into account everything from fire safety and food preparation to staffing levels and residents suffering from bedsores, elder care advocates and nursing home operators agree the ratings are flawed and only a starting point for consumers looking to pick the best place for themselves or a family member.
“Everyone wants to have an easy way to look up homes,” said Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, which represents more than 5,000 mostly nonprofit nursing homes and other long-term-care providers. “The concept is a good idea. But they’re not really measuring the most meaningful things, like patient- and staff-satisfaction surveys, nor do the stars take into account the patient caseload.”
The Scripps Howard analysis of the 15,700 nursing homes included in the federal rating system revealed an uneven level of quality across the nation and showed how complicated it is to find a good nursing home.
Facilities run by for-profit corporations, which make up about two-thirds of all nursing homes, generally get lower scores than those run by nonprofits organizations. Homes with more than 100 beds tend to get lower scores in all categories.
Yet, all of the highest-rated facilities on the Treasure Coast are for-profit businesses with more than 100 beds, most of which could be used by Medicaid patients. The daily rate for private-pay patients at each of the nursing homes is about $190, and administrators say they strive to go beyond state requirements.
Officials with the Centers for Medicare and Medicaid Services said they want to add patient-satisfaction ratings and more comprehensive staffing information to the ratings Web site. In the meantime, both CMS officials and nursing home quality advocates say the best use for the ratings is to narrow consumers’ search.
People can go to the site, find the best-rated facilities nearest them and then do what everyone — even administrators at the Treasure Coast’s top-rated facilities — agrees is the only real way to pick a nursing home: Visit the home. Visit unannounced. Visit often.
“You have to come see us,” said Edwin Rojas, administrator of Atlantic Healthcare Center in Vero Beach. “You wouldn’t buy a car without seeing it, without driving it. ... It’s the same way. You have to go to the facility.”
People should be checking for cleanliness, staff friendliness and nurse-to-patient ratios, residents’ demeanor and whether the facility can meet any special needs. Anything you’d check at a day care, you should check at a nursing home, said Elizabeth Davis, public relations manager for the ombudsman office of the Florida Department of Elder Affairs.
And don’t discount a first impression.
“You need to trust your gut, basically,” Davis said.
Although administrators said they are seeing more consumers aware of the federal ratings, residents of the top-rated Treasure Coast facilities mostly found their nursing homes — which they say treat them well — through word of mouth and those gut feelings.
Elizabeth Lappie, 76, has lived at Palm Garden in Port St. Lucie for a year. Her husband Herbert, 75, has been there for five years and Lappie’s many visits to see him made her think Palm Garden was the place for her, too.
“I just got to know everybody, so when I had to be put in some place, I came here,” Lappie said.
The Lappies selected Palm Garden in the first place mostly because it was close to their home, a decision elder care advocates and nursing home administrators applaud. Regular visits are important to residents, but also tend to lead to more and better care, according to elder care advocates.
“It’s easier to manage day-to-day life when their family members are here,” said Jay Mikosch, Palm Garden administrator.
Other things consumers might look for when searching for a nursing home are lawsuits.
At least one nursing home in each county — and in some cases, it’s a highly-rated facility — has lawsuits pending or settled, according to a Scripps Treasure Coast Newspapers analysis of court records. Many of the suits against the nursing homes are for negligence or wrongful death, and most of those were settled out of court.
Meanwhile, Martin Nursing and Restorative Care has sued 37 patients since 2005 for payments. The facility has not had suits brought against it since 2005.
But even lawsuits are no definite indicator of quality, said Aubrey Posey, legal advocate for the Florida Department of Elder Affairs. Homes might choose to settle for business reasons; lawyers might bring multiple suits once they find a facility willing to settle.
Ultimately, consumers need to look at the whole of a facility’s qualifications and visiting is key to that evaluation.
“The lawsuits and ratings are certainly things to look at, but it doesn’t replace just being there at different times of the day,” Posey said.
— Scripps Howard News Service and staff writer Melissa Holsman contributed to this report.
CHOOSING A NURSING HOME
1. Decide what the patient needs: A clear diagnosis from medical providers and social workers can determine whether a nursing home is the best place for the patient or if he needs a home that specializes in a specific kind of treatment or care.
2. Stay close to home: More family visits often translates to more care at a nursing home. The squeaky wheel does get the grease.
3. Check the ratings: The Nursing Home Compare Web site — www.medicare.gov/NHCompare — is a good place to start your search.
4. Drop in for a visit: If you can, skip an appointment to get a real feel of what day-to-day operations are like. Make sure to meet with an administrator and ask about care planning, specialized services, safety systems, policies and costs.
5. Visit again at a different time: You want to make sure the nursing home is more or less the same during busy meal times and quiet evening hours.
6. Take a bathroom break: Any public restroom gives you a basic idea about a facility’s cleanliness, but also check for hot water — which might be lacking in big homes — and signs of disrepair.
7. Stop by the kitchen: Make sure the food’s tasty while you’re checking if there’s a licensed dietitian on staff and how they handle food allergies and special diet needs.
8. Chat up the staff and residents: Elder care advocates say the best facilities often are the ones that feel the least like a hospital. Notice where residents are, what they’re doing and how they look. Are they being cared for in a dignified manner? Are the staff friendly to them and to you? Are people talking?
9. Ask questions: Don’t limit yourself to administrators, though they are a great place to start getting information. Talk to residents and sit in on a residents’ council meeting. Check on staff turnover rates and training opportunities.
10: Buy yourself some time: If you — like about half of all nursing home admissions — are looking for a facility after a hospital stay, you might have just a day to decide which is the best place for you. File an appeal of the hospital discharge to buy yourself an extra two days to check out nursing homes.
Sources: AARP; District of Columbia Long Term Care Ombudsman, NCCNHR (formerly National Citizens’ Coalition for Nursing Home Reform), Medicare.
ABOUT THE NURSING HOME RATING SYSTEM
The Centers for Medicare and Medicaid Services collect data on all nursing homes that care for Medicare or Medicaid patients and displays the information at www.medicare.gov/NHCompare.
The rating system is on a scale from one star to five stars, with five being the highest rating. Rankings are updated every three months, and some data are revamped monthly.
There are about 15,700 nursing facilities listed on Nursing Home Compare. The ratings do not cover facilities that accept only privately insured patients or those that, for instance, only care for people who already reside in an affiliated assisted-living complex. They also exclude group homes or “personal care” homes that don’t provide skilled nursing services.
Because state assessments vary, nursing homes from different states should not be compared.
Scripps Howard News Service
BEST AND WORST RATED TREASURE COAST NURSING HOMES
To search the complete database of nursing home ratings, visit TCPalm.com.
Indian River County
Best: Atlantic Healthcare Center, 4
Worst: Willowbrooke Court at Indian River Estates, 1
Best: Edgewater Manor, Parkway Health & Rehabilitation Center, Stuart Nursing & Restorative Care Center, 4
Worst: Palm City Nursing & Rehab Center, 2
St. Lucie County
Best: Palm Garden of Port St. Lucie, Life Care Center of Port St. Lucie, 4
Worst: Emerald Health Care Center, Fort Pierce Health Care, Tiffany Hall Nursing and Rehab Center, 1
Centers for Medicare and Medicaid Services