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Boston Globe
Survey details
disparities in nursing homes
By Stephen
Smith, Globe Staff, 11/13/2002
The federal government
released a sweeping review of nursing homes yesterday, giving consumers the ability
to compare thousands of homes nationwide and showing significant differences among
Boston-area facilities in key areas of resident care, including pain and the incidence
of bedsores.
In some local nursing
homes, as many as 16 percent of patients had bedsores, a complication often associated
with lack of attention from caregivers. In others, as few as 2 percent had those
sores. Similarly, 1 percent of long-term patients in one nursing home were reported
to be stricken with persistent pain, while that figure stood as high as 18 percent
at another facility.
The study is the
most comprehensive effort ever by federal regulators to measure and publicize
the quality of nursing home care across the nation. It also represents a broader
movement in health care to offer objective assessments of how well doctors, nurses,
and health-care facilities are performing.
''We feel that
we need to raise the bar even higher to reach for the next level of quality and
care and that effort must include all of us - the federal and state government,
consumers, and the nursing home industry,'' said Brian M. Cresta, New England
director of the US Department of Health and Human Services, which oversaw the
study.
The report emerges
at a time when nursing homes are confronting increasing costs, shrinking government
reimbursements for care, and a shortage of nurses. Nursing home administrators
acknowledged yesterday that the need for consumer information has never been more
critical, as the country's millions of baby boomers face the prospect of caring
for their parents - and planning for their own elder years.
''Choosing a nursing
home is an emotional experience and sometimes a difficult one,'' said Kathleen
E. McCarthy, president of MassPRO, the agency working with the government to provide
the ratings. ''It can cost a family anywhere from $60,000 to $100,000 a year.
You don't want to commit to that kind of investment until you understand your
options.''
The study surveyed
17,000 nursing homes, including 502 in Massachusetts. It evaluates each facility
in 10 categories. In addition to measuring the incidence of bedsores and pain,
it documents what percentage of residents suffer infections, how many cannot perform
daily activities, and how often patients are bound by physical restraints, among
other factors.
The data were reported
by nursing home workers, who collected the information earlier this year. Federal
authorities said yesterday they believe that, on average, it is a fair reflection
of conditions in nursing homes. They plan to update the findings on a regular
basis, but officials have not yet set a schedule for the reports.
The full report
is available to consumers at the Web site www.medicare.gov and at 1-800-MEDICARE.
The government's
Centers for Medicare and Medicaid Services bought newspaper advertisements across
the country listing results for the 50 largest nursing homes in each metropolitan
area. In the Boston region, two of those homes shared the distinction of having
the highest percentage of patients with bedsores, 16 percent: Radius HealthCare
Center at Southbridge and Sarah S. Brayton Nursing Care Center in Fall River.
The executive director
of the 226-bed Radius, Richard Corey, said yesterday that he had been aware of
his nursing home's ratings long before publication of the report. Not long after
he arrived as top executive of the nursing home in March, Corey said, he recognized
the facility's shortcomings.
''We knew our track
record wasn't acceptable,'' Corey said. ''We took that very seriously and knew
we had to come up with new methods of making sure those numbers became acceptable.''
Corey said he has
retrained staff, emphasizing the importance of regularly turning patients to prevent
sores, as well as treating wounds attentively if they do develop. Nurses and incontinent
patients prone to bedsores, he said, worked together to better schedule restroom
visits.
The result: The
rate of bedsores now stands at 8 percent, according to the home's own measures,
slightly below the statewide average of 9 percent.
At Sarah Brayton,
an administrator said the high numbers can be misleading. The survey doesn't factor
in the often daunting complexities of caring for the elderly, said Dr. Mark Levy,
senior vice president of medical affairs for Genesis ElderCare, the facility's
owner.
For instance, not
all nursing homes admit patients arriving from hospitals with bedsores.
''What this doesn't
separate out is what are pressure sores that were actually developed in the hospital
and what are pressure sores developed in the nursing home,'' said Levy, who also
pointed out that the study doesn't report on the severity of sores.
Two of the nursing
homes that fared best are Benjamin Healthcare Center in Boston and Braintree Manor
Rehabilitation and Nursing Center. Benjamin reported only one-third as many residents
with bedsores as the statewide average, for instance, and while an average of
9 percent of patients across the state suffered regularly with pain, only 4 percent
of Benjamin residents did.
Administrators
at both Benjamin and Braintree credited the same source for their success: their
employees.
Stephen Smith
can be reached at stsmith@globe.com.
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