Fifty-four nursing homes are being told by the government that they're among the worst in their states in an effort to goad them into improving patient care.
Lawmakers and advocacy groups have been pushing the Bush administration to make it easier for consumers to identify poorly performing nursing homes. They complain that too many facilities get cited for serious deficiencies but don't make adequate improvement, or do so only temporarily.
The administration agreed, and the Centers for Medicare and Medicaid Services will list the homes on its Web site Thursday.
"Very, very poor quality nursing homes do not deserve to be left untouched or unnoticed," said Sen. Herb Kohl, D-Wis., chairman of the Senate Special Committee on Aging. "This is not to be punitive. That's not our goal. Our goal is to see to it that the people in these nursing homes get better quality care or that they get the opportunity to move somewhere else."
The homes in question are among more than 120 designated as a "special focus facility." CMS began using the designation about a decade ago to identify homes that merit more oversight. For these homes, states conduct inspections at six month intervals rather than annually.
The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey.
The nursing homes to be cited come from 33 states and the District of Columbia, according to a list obtained by The Associated Press. There are about 16,400 nursing homes nationwide.
Nursing home administrators have concerns that homes showing significant improvements will still show up on the Medicare Web site. They said it takes time for inspection results to make their way through the bureaucracy. Still, administrators support the concept of greater disclosure, said Bruce Yarwood, president and chief executive officer of the American Health Care Association, the trade association for nursing homes and other long-term care facilities.
"Every time you go under a microscope like that, especially in our profession, you want to get out from under that microscope," Yarwood said. "There will be a heck of a lot of effort not to stay there."
One of the homes on the government's list was Franklin Hills Health & Rehab Center in Spokane, Wash. Brian Teed, the facility's administrator, said he did not have a problem with Medicare publicizing the list. But he said regional differences play a huge role in how nursing homes are graded. He said he recently helped run a facility in Portland, Ore., and nursing homes were graded much easier there. He took over the Spokane facility in September, and found it to be well run.
"In the Portland, Ore., area, this facility would be deficiency free or close to it. Instead we got 15 tags. We got tagged because there was bird poop on the bench outside," Teed said.
"I would put my mother in here," he added.
About 1.5 million elderly and disabled people live in nursing homes. Taxpayers spend about $72.5 billion a year to subsidize the cost of nursing home care.
Every nursing home receiving federal payments undergoes inspections about once a year. In such inspections, surveyors assess whether the facility meets standards focused on safety and quality of care. Among the things inspectors look for are giving residents the proper medicine, assisting them with daily living activities such as bathing, and assisting them with their medical needs and diet, as well as the prevention of accidents and infections.
Typically, homes that get the special focus designation do show improvement. Federal data indicate that about half the special focus homes improve their quality of care significantly within 24-30 months. However, about 16 percent are terminated from Medicare and Medicaid.
Sen. Charles Grassley, R-Iowa, said he's concerned about those homes in between — the ones that don't make much improvement but still continue operating.
"The federal agency responsible for nursing homes is doing the right thing by letting the public know which homes yo-yo in and out of compliance with the minimum requirements of care," Grassley said. "It gives these nursing homes the incentive to get off of that list, and it lets consumers know what they're getting into."
Kerry Weems, acting administrator at the Centers for Medicare and Medicaid Services, said states pick from a list submitted by CMS when determining those that get the special focus designation. He said that because of regional differences, a home that makes the list in one state may actually provide better care than a home that's not listed in another state.
"I'm careful in saying they're not the worst performers, but they are chronic underperformers," Weems said.
Weems said he hopes that naming the homes makes it easier for them to improve.
"We're hopeful making this disclosure will put the right kind of pressure, helpful pressure, on the facilities to move to the path of improvement rather than the path to termination," Weems said.
The AARP also applauded the administration's action.
"People in nursing homes have a right to know how well they're performing," said David Certner, director of legislative policy for AARP, an advocacy group for people 50 and older. "Their families certainly have a right to know what kind of care their relatives are receiving and if that care is substandard."
Medicare officials said families with relatives in a special focus nursing home should visit the home and talk to staff and residents. They can also review the survey history for the home on Medicare's Web site called Nursing Home Compare.
Another source of information about a home is the state's nursing home ombudsman.