By Lori Smetanka
Let’s be honest. People don’t think about
nursing home quality until they or a loved one need care. Recent studies show
that as many as half
of Americans will live in a nursing home at some point in their lives,
either for the short term, such as a rehabilitation stay, or because they need
the long-term care and services that a nursing home provides.
Regardless of how they come to live in a
nursing home, all consumers and families want the best care possible. Being
able to make an informed decision about the facilities under consideration is a
critical element in the ability to receive quality care; and consumers need
reliable, accurate information in order to make the best decision possible.
A Step Toward Transparency
This past June, Sens. Bob Casey (D-PA) and Pat
Toomey (R-PA) released an April 2019 list of nearly 400 under-performing
nursing homes that were candidates for the Centers for Medicare & Medicaid
Services (CMS) Special Focus Facility (SFF) program. It’s a win for consumers,
who should be privy to which facilities have a “persistent record of poor care”
and are thus subject to increased oversight and enforcement actions by CMS and
State Survey Agencies.
Previously, only those facilities selected for
the SFF program (88 facilities nationwide) were disclosed to the public.
According to CMS, the nearly 400 facilities on the candidate list are eligible
for the SFF program, meaning they have a history of serious quality issues over
the prior three-year period. SFF facilities have about twice the average number
of deficiencies as other nursing homes, and the problems cited generally
include harm or injury to residents, and that problems have persisted over the
three-year period prior to first being placed on the SFF list.
Candidate nursing homes meet all these same
criteria for the program but have not been selected due to what CMS described
as “resource
limitations”—inadequate budget and staff to conduct more
frequent oversight of these facilities with serious deficiencies. (Visit for
more information about the SFF program.)
Dr. Kate Goodrich, director of the CMS Center
for Clinical Standards and Quality and chief medical officer, released a
statement just days after Sens. Casey’s and Toomey’s report, indicating that
CMS will begin posting the SFF candidate list, although she did not disclose when
the list would be posted or where it will be made available. Advocates for
nursing home residents and their families applaud the senators for their
advocacy and support the decision from CMS to begin releasing the candidate
list.
More Supports for Consumer Choice
However, more must be done, including working
for greater transparency of information about each nursing home, such as survey
history and ownership information, and providing more information to consumers
about facilities that meet the SFF criteria. This can ensure that consumers
have the information necessary to make an informed decision about a
long-term-care facility.
The list of SFF candidates is only useful if
it is accessible and timely. Consumers must be able to easily find out if a
facility is an SFF candidate. For instance, SFFs are noted
with a cautionary symbol on Nursing Home Compare. One option is
for CMS to give SFF candidates a special notation as well.
Nursing Home Compare should also be improved
with respect to the information shared about facilities on the special focus
list and the candidate list. CMS recently removed the star ratings from SFFs,
indicating that they are “not available.” A user has to hover over a footnote
on the page to learn that the lack of star ratings is due to a history of
chronic poor quality. This could be more prominently displayed.
For SFF candidates, there is no designation
that the facility is a chronic poor-performer or candidate for the SFF program,
and while many have low overall star ratings, some show quality measures or
staffing ratings of three stars or higher. This could raise the overall
facility star rating. It is misleading to the public to see a facility
designated as an SFF candidate, which at the same time has star ratings of
average or above. CMS must revise, audit and-or improve the data used to establish
star ratings on Nursing Home Compare to address this discrepancy.
Advocates Must Demand Transparency
As advocates for older adults needing
long-term care and services, it is incumbent upon us to demand transparency
and access to timely, accurate and understandable information so that consumers
can make informed decisions. Steps to take include the following:
·
Advocating with CMS to
immediately make the monthly list of SFF candidates publicly accessible and to
designate candidate facilities on Nursing Home Compare;
·
Educating consumers
about the SFF program and sharing the list of SFFs and candidates with those
seeking information about long-term-care options;
·
Asking and encouraging
consumers and families to ask administrators of SFFs and candidate facilities
what is being done to improve care;
·
Educating consumers
about what to look for in a long-term-care facility; and
·
Contacting the Long-Term Care
Ombudsman Program and State Survey Agency for more information
about local nursing homes, or to raise concerns about quality care, quality of
life or violations of rights.
Consumers deserve any and all supports that
can help them to make informed decisions when selecting a long-term-care
facility, to the extent that choice is available. They can only do so with
timely, accurate information about all facilities under consideration.
Information transparency is critical for consumers. Their health and well-being
depend on it.
Lori Smetanka is executive director of the
National Consumer Voice for Quality Long-Term Care, in Washington, D.C.
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