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Nursing-care
ratings go national: State-tested 'report card' intended to guide consumers, encourage
quality
By Marsha King
Seattle Times staff reporter
11-12-02
A controversial
federal project, tested earlier this year in Washington state, will be rolled
out today nationwide to give consumers more help with the tough job of finding
a good nursing home.
The Centers for
Medicare and Medicaid Services will release a "report card" that rates about 17,000
nursing homes across the country on 10 indicators of quality.
The public can
learn, for example, what percentage of residents in a nursing home have chronic
pain and infection or can't perform routine tasks, such as going to the bathroom
alone.
The mountain of
data on individual homes will be compared to state and national averages and is
expected to be posted today on the Internet at www.medicare.gov.
Its release is expected to be heralded by government officials at a news conference
in Washington, D.C., and at local media events around the country. Nursing-home
data also will appear in abbreviated form in about 70 major newspapers tomorrow,
including updated statistics on Washington's nearly 270 nursing homes.
Advertising also
will start running in the Seattle area, eventually going statewide, that provides
names and telephone numbers of agencies that can help consumers make choices about
nursing-home care.
The new Nursing
Home Quality Initiative was tested for six months earlier this year in Washington
and five other pilot states — Florida, Maryland, Colorado, Ohio and Rhode Island.
One of the most
praised parts of the initiative is the least visible to the public.
The Centers for
Medicare and Medicaid Services expect to contract with private "quality-improvement
organizations," or QIOs, in every state to help some nursing homes do a better
job of assessing and meeting residents' needs. The cost of the contracts will
be $120 million over three years.
During the pilot
phase, a Seattle company called Qualis Health helped a small group of nursing
homes learn more about how to manage pain. In the next phase, Qualis will work
with more nursing homes and will add training on pressure ulcers and physical
restraints to the focus on pain.
At Bessie Burton
Sullivan Skilled Nursing Residence in Seattle, staff members added a question
on the satisfaction survey given to discharged patients about how well their pain
was managed. They also found that using the right language can make a difference
in figuring out what a resident needs.
Some residents
will say no when asked, "Are you in pain?"
But if staffers
ask, "Does your knee hurt?" they'll say, "Yeah, it's killing me."
At Tacoma Lutheran
Home, the staff now is taking a more comprehensive history of residents' experiences
with pain and how they managed it in the home setting, including the use of remedies
such as ice packs or massage.
The goal used to
be keeping residents pain-free. Now, staff members know that managing pain can
mean keeping a patient pain-free in order to succeed with a rehabilitation program.
Or it could mean allowing a patient to live with a minimum amount of pain to avoid
oversedation and achieve a higher quality of life.
"A holistic approach
helps us achieve the patient's personal comfort level," said Sharon Christor,
director of nursing.
Meanwhile, the
quality measures to be published today still raise debate.
Some say the measures
on the whole serve a good purpose.
"This is the first
time people have had the opportunity to have comparative data about nursing homes
— clinical data. I view that as a start," said Jill Hacker, a nursing-home resident
in Shoreline. "They've taken the things that are probably the most-common occurrences
and the easiest to quantify."
Hacker, who served
on a committee that helped shape the pilot project in Washington, says more measures
will be added eventually. She's hoping that will include indicators of residents'
quality of life.
Some long-term-care
experts and government officials, however, say consumers should use the quality
measures as one tool among many — including the most important, personal inspection
— in choosing a nursing home.
Others question
the data's reliability and usefulness, as critics did during the pilot phase.
Some also ask whether the whole project is the best use of government money, especially
in times of tight budgets.
"They're spending
millions and millions of dollars on this when the money could be used for more
direct purposes, such as more staff, more quality-assurance nurses, better funding
for facilities," said Louise Ryan, assistant state long-term-care ombudsman.
"Hands down, residents
say we need more staff. ... I think that's what people really want."
Marsha King:
206-464-2232 or mking@seattletimes.com.
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