Skilled Nursing Facilities Ratings Change

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Many facilities score lower under tougher standards
Peter Eisler and Christopher Schnaars USA TODAY 2/22/15


WASHINGTON Nearly a third of the nation’s nursing homes are getting lower scores on the government’s five-star quality scale, a reflection of tougher standards for ratings used by nearly 1.5 million consumers to assess care at more than 15,000 facilities.
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About 61% of all nursing homes got lower quality-of-care scores as a result of the changes, but the declines weren’t dramatic enough in most cases to affect a facility’s overall rating, a USA TODAY analysis shows. About 28% of nursing homes dropped one star in their overall ratings, including more than 1,200 that lost their coveted five-star status. About 3% of facilities fell two stars.

•The average overall rating among all nursing homes dropped from 3.46 stars to 3.14 stars. Only 341 homes, or 2.3%, saw their overall ratings increase under the new measurement system.

•The biggest drops came in scores for quality of care, where the average for all nursing homes fell from 4.18 stars to 3.3 stars. No ratings category changed more, not only because it reflects the addition of data on anti-psychotic drugs, but also because other quality measures were made tougher.

•Nearly 20% of all nursing homes got the lowest possible score on the new measure of anti-psychotic drug use — CMS scored them on a curve, giving one star to homes ranked in the bottom fifth. Facilities were docked for using the drugs on residents unless they were indicated for specific conditions, such as schizophrenia, Huntington’s Disease or Tourette’s Syndrome.

“High rates of anti-psychotic use can indicate serious care problems, because they’re using them (to drug residents), instead of having adequate staffing and truly meeting residents’ needs,” Grant says. “When you’re using anti-psychotics, your residents could be suffering increased falls, they’re immobile, so you can see increases in pressure ulcers. They’re very problematic.”

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