BY MARK PARKINSON, OPINION CONTRIBUTOR — 01/12/20
04:00 PM EST 35
THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN
AND NOT THE VIEW OF THE HILL
Anyone
who has ever worked in an office setting with a communal refrigerator has – at
some point – had food go missing at the hands of a hungry or mistaken
colleague. Few would consider this some form of abuse that raises larger
questions about the quality of the workplace.
Unfortunately,
changes to an important source of information for nursing home residents and
their families recently
implemented by the Centers for Medicare and Medicaid Services (CMS)
could cause minor incidents, such as missing food, to mislead consumers about
the broader quality of care provided by a facility.
Keeping
nursing home residents safe and healthy is the No. 1 priority of thousands of
dedicated caregivers across the country. Even one case of abuse or neglect is
one too many. An important aspect of abuse prevention is transparency.
Nursing
home residents and their families should be empowered to make informed
decisions on care. Nursing Home
Compare, a website maintained by the federal government that
provides information about skilled nursing centers, is a valuable tool in the
effort to provide consumers with more information. Data on the site is obtained
through Medicare and Medicaid claims, as well as annual inspections. The
website uses this information to assign facilities an overall rating of one to
five stars, as well as ratings for specific areas that include staffing,
quality of care and regulatory compliance.
Beginning
on Oct. 23, 2019,
CMS made changes to this program so that reviews of facilities cited for one of
three standards of abuse and neglect display an icon to warn consumers. The
icon consists of a red stop sign with a hand on it. On its face this may seem
like a straightforward method to convey information to the public. However, a
closer examination reveals that rather than improving transparency, this new
icon may lead to greater confusion and uncertainty.
A
couple of real-world
examples that would result in the new icon being displayed
illustrate this point. One example involves missing food. A resident of a
dementia care facility was storing guacamole in a communal refrigerator. It
went missing. As this is classified as “misappropriation of property,” the
facility is obligated to report this to the state authorities, and it could
result in an abuse citation.
Another
example involves two residents leaving their facility’s dining room at the same
time in wheelchairs. They bumped into each other. Neither resident was injured,
but this too resulted in an abuse citation.
Regardless
of the overall quality of care at these two facilities, both could be subject
to the new alert icon on the Nursing Home Compare website. Facilities that
receive the new icon also have their five-star ratings capped at two stars,
which will mask information from other important quality concerns that impact
this rating. This is inconsistent with the stated goal of
CMS to help “consumers develop a more complete understanding of
a facility’s quality.” The symbol could lead people to avoid a facility
altogether based on incomplete information.
There
are better ways to increase transparency that would be less prone to mislead
consumers. For instance, using an icon that indicates the need for closer
examination – such as a yellow triangle with an exclamation point – instead of
outright avoidance, would be more appropriate.
In
addition, CMS should add customer satisfaction to Nursing Home Compare, because
that is the best way for consumers to select facilities. While virtually
all other health
care sectors, such as hospitals,
have a CMS reporting requirement on satisfaction, skilled nursing does not. Making
this information available to future residents and their families will go a
long way toward enhancing transparency.
Ultimately,
the most surefire way of ensuring transparency is for those choosing a nursing
center for themselves or a loved one to make visits to facilities in their
area. There they can ask questions about the specific services provided, ask
questions of staff, other families and residents, and learn about payment
options.
As we
work to increase transparency and eliminate any instances of abuse and neglect,
it is vital that we do so in a way that makes information easier to understand
for the people we serve. Misleading, ambiguous information is a step in the
wrong direction.
Mark
Parkinson is the president and CEO of American Health Care Association and
National Center for Assisted Living.
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