According to US News and World Report, less than 20 percent of nursing homes can be rated as best. The company released its rankings for 2019 and 2020 on October 28.
Rankings for these nursing homes come from all 50 states as well as almost 100 major metropolitan areas. California has the most at just under 170 ranked at high-performing for short-term care and 157 for long-term care. Pennsylvania and Florida came in second and third.
For those states with the highest total proportion of nursing homes that rank best, Hawaii, Washington DC and Alaska were at the top of the list. At least half of the nursing homes had a high designation for other short- or long-term care.
For the total around the country, the numbers are discouraging. There were 15,530 homes evaluated and only 2,969 met the necessary criteria to be listed as high performing. Only 2,250 were labeled as best for short-term rehab while 1,139 were granted the designation as bet for long-term care. Of the total, only 420 facilities received the designation for both categories.
Critics say that stricter standards need to be applied. The rating system measured the facility’s performance on staffing, health inspections and quality. The issue is that it was measured against other nursing homes located within the state. The result is that each nursing home is compared to others within the state, which may not be a good gauge of overall quality of care.
How Ratings are Compiled
Short-term care is described as less than 100 days, and it is most often used for patients recovering from surgery, stroke, heart attack or other conditions. Long-term care is defined as more than 100 days.
For both categories, facilities were studied based on the staffing levels seen and the consistency at which they were staffed adequately. The study also looked at the percentage of patients who returned home after short-term care. They studied the frequency that long-term patients required hospital care as well. In total, ten metrics were included to measure short-term rehab and nine metrics were used for long-term care.
These ratings are useful to anyone considering a stay in a nursing home or for family members choosing a facility. While the ratings are far from perfect, they do provide a starting point for research. Experts recommend looking at all the criteria since people often place value differently on what they are looking for in a short-term rehab facility versus long-term care.
Potential residents and their families can review the information and discuss where the facility falls short and the reasons why. They can look at which homes are average and below average as well as those that rank at the top and determine what it means for their needs. Home inspection reports are another important part of the decision process along with patient satisfaction surveys. This information taken together can help everyone make an informed decision on the best place for the elderly or recovering person to go.
Concern About Elderly Care Fuels Concern Over Reopening Long-Term Care Facilities
Nursing homes and assisted living facilities closed their doors to visitors, including family members, amid the spread of the coronavirus. Protecting the most vulnerable population, these facilities have kept residents isolated for months. However, some families want to know when the facilities will reopen their doors.
Family as Unrecognized Caregivers
Many family members have made the visit to elderly loved ones daily or multiple times a week. They don’t just visit with their aging loved ones. They also help them with certain tasks and ensure they are being cared for adequately. Adult children who visit may assist the elderly parent with cutting food into bite-size pieces or help them reach their drink while they eat.
These family members also act as monitors to ensure the loved one gets their medications, a shower and other personal care as they are supposed to. While the majority of facilities provide quality care, overworked employees and understaffed departments may not always meet the needs of the residents. They may neglect or even abuse residents who cannot help themselves or tell others. Visiting family can help prevent their loved one from falling victim by checking in with them and watching their behaviors and for other signs of neglect.
With the pandemic, most facilities have closed to the public and stopped family visits. Residents are isolated inside and with no in-person interaction with family and friends. While that often isn’t the intention of the facility, they may not be able to provide for the social needs of every resident.
As other businesses and organizations have eased restrictions, families want to know when visits will be allowed in these long-term care facilities. In some cases, a type of visit has been allowed. Some centers allow families to visit with their loved ones outdoors, often over a fence. Eating in dining rooms while socially distancing has also resumed in many facilities. This allows the residents a chance to see other people and get out even if they can’t be in close contact.
Concern grows for the residents’ mental health as well. Because they can’t do the things they once were able and now have no one to visit them, they often feel lonely and depressed. They lose their appetites and have no motivation to fight through this pandemic. While nursing homes and assisted living centers have been hotspots for many deaths from COVID-19, family members and others worry about various long-term effects and the detriments of isolation for this fragile population.
While numerous states have provided guidelines to these facilities on safe reopening practices, the majority of centers have yet to allow in visitors. For those that do, family members still don’t feel they get a good idea of how their loved one is doing. They may see them at a distance or only for a short time. Neglect has always been a concern in these facilities, which is heightened because no one is around to monitor the patient and ensure they are safe and cared for.
Government Increases Scrutiny of Nursing Homes
Health inspectors are being sent by the Centers for Medicare & Medicaid Services to nursing homes as well as hospitals to check on the practices in place for infection control. The main attention is going to areas where the coronavirus has been identified.
More Attention on Infection Control
The increase in attention comes from the five deaths of residents at Life Care Center in Kirkland, Washington who had all been infected with the coronavirus. The inspectors would be looking at whether the correct protocols were in place and if the staff had followed the rules on infection control. This same facility had been cited in the past year for lapses in infection control, but the issues had been corrected, according to inspectors.
The inspectors will be looking at handwashing practices, whether staff are wearing gloves, how laundry is being handled and food preparation, among other things. While the leaders in the nursing home industry have said they support this plan, they also ask about dealing with possible shortages of critical supplies, including masks.
According to CMS, nursing homes have the ability to ban visitors to protect their residents. They can also screen each person who visits the facility to determine if they have traveled overseas recently and where.
Poor infection control is the number one reason for citations with nursing homes. Statistics show that over 9000 nursing homes have been cited in the past three years. These citations vary from basic hygiene to other preventative measures to control infection. Over one-third of those nursing homes have been cited more than once.
Many of the violations are considered lower level, which means they don’t come with fines. They also don’t impact the rating of the nursing home.
Infections in these facilities can be quite serious and often include extended hospital stays for recovery. Many don’t recover from the infections. For example, residents who have feeding tubes are at an increased risk of aspiration pneumonia and skin infections. While older people are more susceptible to these infections because their bodies can’t fight off disease as easily as someone younger, there are also concerns that staff members aren’t trained to monitor for these conditions, or they simply overlook indications of infection.
The Department of Justice Gets Involved
The US Department of Justice has created a task force to focus on substandard nursing home care. The areas of main priority include understaffing and poor infection control as well as neglect and abuse of residents. The DOJ plans to build training materials to assist law enforcement deal with the abuse and neglect of seniors in care.
The key areas of the nursing home plan for the CMS include:
- Stronger oversight
- Simpler reporting requirements
- Improved enforcement
- Improved quality measures
- Increased transparency
While the immediate focus is on infection control, the DOJ says it goes beyond that to failure of care for the residents. As part of the announcement of the new task force, the department cited such concerns as residents who develop pressure sores and those who cannot reach their food on trays, so they must go hungry.
Nursing Home Abuse Caught on Camera
A woman from North Carolina was concerned about the care her mother was receiving in a nursing home. Using a hidden camera, she caught video of staff engaging in abusive conduct towards her mother.
Most Abuse Goes Unreported
One day after the camera was installed, the video captured abuse. The first episode was verbal abuse where the attendant yelled at her mother during a change. It then became physical when the assistant moved the woman across the bed in a violent way. The patient cried out in pain.
The daughter took the camera to the director of the nursing home who fired the employees immediately. However, the assistant district attorney failed to file charges against the employees, which means they can find another job in a different nursing home because there are no records of the abuse.
According to a report from the Centers for Medicare and Medicaid Services, one in five emergency room visits for residents from nursing homes are from abuse. Most of the time, the nursing home doesn’t report the abuse to law enforcement or the proper government agency.
A second report was generated that included reviews of more than 34,000 Medicare claims. After reviewing those claims, it was found that almost 90 percent could be linked to possible abuse or neglect.
What Happens with Abuse
Some of the most common types of injuries from abuse or neglect include the following:
- Head injuries
- Severe infections
- Bruises and cuts
- Bedsores in the later stages
One of the reasons it can be difficult to detect abuse in a nursing home is because the elderly are more prone to injury from other situations. For instance, they may fall and break a bone or get a bruise. They may not eat well or drink and become dehydrated. However, repeated incidents of injury, especially when not documented, are signs of possible abuse.
Patients often deny abuse because they are afraid of the repercussions since they must live in the nursing home. They may become quiet and withdrawn, seem upset or fearful.
Another form of abuse is keeping the patient sedated beyond what the doctor prescribed. The person may spend much of their time sleeping, so staff members don’t have to tend to them as often. If the patient seems groggy or is sleeping a great deal more than what seems normal, it should cause you to question what is going on.
You may be unable to get information from your elderly loved one about the abuse. However, you can report it to the authorities if you suspect abuse or neglect has occurred. It’s important to remove the person from the living environment as quickly as possible. You can also contact local authorities to have the nursing facility investigated.
Removal to a new facility should cause a change in the patient. They may now feel more secure in opening up about what happened if they are able. You will also likely notice improvement in their health and a reduction in injuries in the new environment.
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