Editor’s note regarding anonymity:
— Avamere resident and veteran requested to be anonymous because of fear of previous private caregiver and protection against unstable ex-wife.
— Sequim Health and Rehab resident requested to be anonymous because of fear of negative backlash from the administration.
by ALANA LINDEROTH
Sequim Gazette
Revamping the way skilled nursing facilities are rated, federal officials announced earlier this month the three criteria used to create a Medicare rating will undergo additional oversight.
The new ratings — a one- through five-star system, with more stars signifying above average quality — are designed to reflect the quality of more than 15,000 nursing homes, including Sequim Health and Rehabilitation and Avamere Olympic Rehabilitation of Sequim.
The system went public Feb. 20 at Medicare’s Nursing Home Compare website.
Since the rating updates, Sequim Health and Rehabilitation went from five stars (much above average) to three stars (average) while Avamere went from three stars to four (above average).
The three criteria that equate to a rating consist of staffing, quality measures and health inspections.
Until recently, both the staffing data and quality measures were internally produced by each facility and, according to the Medicare website, “nursing home inspectors review it, but don’t formally check it to ensure accuracy.”
To begin addressing unverified data used to produce a certain number of stars, Medicare officials now require nursing homes to report staffing levels quarterly, which is verified with payroll information and for the first time the new ratings will reflect each facility’s use of antipsychotic drugs.
Medicare’s starring system has become a consumer tool since it began in 2009 in an attempt to provide more transparency and therefore greater accountability among skilled nursing facilities.
A local look
Though Sequim Health and Rehabilitation historically has ranked highly in Medicare rating, the Extendicare-owned facility — along with 33 Extendicare facilities and its subsidiary, Progressive ProStep Corp., named in a settlement — is participating in a five-year corporate integrity assessment with the U.S. Department of Health and Human Services.
Officials with Extendicare Health Services Inc., one of the country’s largest long-term care providers, agreed to pay $38 million back to federal health care programs, including Medicaid and Medicare, following a federal investigation. According to the settlement agreement, the federal government contended some of skilled nursing services at the involved facilities were “materially substandard and/or worthless because Extendicare failed to provide care to residents that meets federal standards of care.”
A high number of stars didn’t exempt some Extendicare facilities from the settlement. A four-star Washington Extendicare facility was directly involved in the settlement while the other Washington state facility also involved had only two stars.
“There really isn’t any correlation between a facility’s star rating and the settlement,” Edward Ebling, Sequim Health and Rehab administrator, said.
Regardless of the imperfections of Medicare’s star system, Ebling said he still feels when a facility achieves five-stars, “It’s a great accomplishment.”
Medicare’s system attempts to provide a consistent rating criteria to compare skilled nursing facilities to one another, which is “at least something and a good start,” Ebling said.
Avamere administrator Heather Jeffers said when she was a discharge planner, she would tell people to look at the star ratings, but “if you don’t understand it, then don’t bother because it can be misleading otherwise.”
“Looking further than the number of deficiencies, but knowing the type of deficiencies is important because they can be reflective of the other potential problems,” she said. For instance, she said, reoccurring falls may indicate a staffing shortage or a trend of resident weight loss could result from a nutrition problem.
Beyond the stars: A ‘say in your stay’
Other than Medicare’s star system, resident councils are a more intimate platform to help ensure quality care.
Resident councils are intended to provide residents the opportunity to have a “say in your stay,” a resident at Sequim Health and Rehabilitation said. The council is supposed to be a safe environment where residents can feel open to speak and share information about their daily life, both positive and negative, the resident said.
“The only voice you have inside a care facility is the resident council in my experience and it should be like talking to your neighbor over the fence because we are a community all living under one roof,” the resident said. “But it has been hard to get our voice out there.”
James Peck, a state certified long-term care ombudsman, said that for short-term residents the council may not be such an important opportunity to share thoughts and opinions because their stay is temporary, but for the long-term residents the council should be a useful tool for holding the administration accountable.
“Many times residents are given complaint forms to fill out, but there is not always proactive follow-through from administration,” Peck said. “Oftentimes there is nobody holding administration accountable.”
Resources
“Nobody seems to think they have rights once they’re in the system,” Meyer, the regional long-term care ombudsman, said. “People in long-term care facilities have exactly the same rights as everyone else.”
To help ensure state quality care standards are being met and provide an advocate of sorts for those that perhaps don’t have family or friends nearby, Meyer has 18 state-certified volunteer ombudsmen assigned to health care facilities, spanning the region from Port Townsend to Forks.
“There is a natural inclination that we all tend to believe that we’re all going to bobble through life and then drop dead one day, but it’s usually not like that,” Meyer said. “If we can get people to ask us the right questions, then we can help.”
Whether it be financial or care concerns, residents at skilled nursing facilities always can request to talk with the ombudsman assigned to that facility, she said.
Additionally, given the complications involved with navigating one’s options when it comes to long-term care, the Information and Assistance office in Sequim for the Olympic Area Agency on Aging offers free and confidential services ranging from how to hire in-home help to planning and decision making to caregiver support and financial concerns.
“We like to think we’re a one-stop shop,” Parris said. “Our staff is trained to ask the next question and we can help counsel individuals on their options.”
To help defuse confusion about what health insurance may or may not cover, free SHIBA (Statewide Health Insurance Benefits Advisors) health insurance clinics are offered from 10 a.m.-noon every Tuesday through Oct. 15 at the Shipley Center, 921 E. Hammond St.
To compare nursing homes using Medicare’s star system, visit www.medicare.gov/nursinghomecompare/search.html.
