Massachusetts Ranked #19 on National Nursing Homes Report Card

Friday, August 16, 2013

Kate Nagle and Avery Stone, GoLocalWorcester News Contributors

Massachusetts recently received a "B" ranking for nursing home quality of care from "Families for Better Care," a national nursing home resident advocacy group -- and earned the #19 top spot in the country overall.
The group published the nation’s "first-ever state-by-state nursing home report card" by analyzing eight federal measures to rank nursing home quality.

Slideshow: See How All Six New England States Ranked Below

According to the findings, Massachusetts scored above average grades on half of the identified measures, which looked at percentage of nursing home facilities with deficiencies, direct care staffing quality and levels, nursing hours and staffing, health inspections above average, and verified ombudsman complaints.

While nearly a quarter of the state's nursing homes had deficiency free inspections, earning MA a "superior" grade, 1 in 4 nursing homes were cited a severe deficiency.

MA Weighs In

"Part of the problem with state by state comparisons is every state is different, but they're all subjected to same types of rules relative to Medicaid. Medicaid lays out how to measure quality - they require states do nursing home inspections every two years, and Massachusetts Public Health oversees process. Based on these inspections, they find if a nursing home has been deficient or not. Deficiencies matter," Ernie Corrigan with the Massachusetts Senior Care Association told GoLocalWorcester.

"I think those grades aren't always a good thing to rely on. I think it's important that when people are looking for a place for a loved one, they see any number of facilities. The question is, which is the best one for them? it's a complicated question. It's not as easy as A, B, C, D. The best thing is to go visit. See for yourself."

"The other issue is that nursing homes in Massachusetts depend upon Medicaid for about 2/3 of their funding. The medicaid rates have not been adjusted to mass in 6 years, and the funding gap over that period of time is more than $300 million. These nursing homes are constantly being required to do more with less. That funding gap between what Medicaid pays for and what it costs is $37 a day for every resident who's on Medicaid - and the number of of nursing home residents who are eligible for Medicaid is approximately 25,000. It adds up."

"I think that you'd always rather have an A than a B, but having said that, the way that we [in Massachusetts] measure ourselves across the country is that we look at a lot of the innovative things that we've done - innovations in care have really started in Massachusetts. Other states can make similar claims to other parts of the system. "

Nursing Home Perspective on Report Card Findings

Sandra Mahoney, Nursing Home Administrator at Wachusett Extended Care, broached the difficulties of assessing different types of nursing care scenarios.

"There are some facilities that focus on traditional long term care - that style of care is very different that focuses on short term rehab. Trying to compare these different types of care with an RN staffing statistic - trying to use good versus bad - is inappropriate when different facilities focus on different types of care."

"I'm a little conflicted about the kind of methodology that went into these rankings. One message I really want to stress is that nursing homes are extremely complicated organizations and its' very hard to simply rank or grade them because they're not homogeneous at any level."

Mahoney echoes Corrigan's assessment of the importance of funding.

"Nursing facilities are primarily funded through Medicaid and Medicare. Each state funds and reimburses differently than the others. It's not necessarily all about ranking the nursing homes - it's also about states and how much they want to give to their nursing homes."

Mahoney also calls in to question what the ranking means overall. "Is [Massachusetts' ranking] 19 good or bad? I don't know that I believe the ranking," she said. "I think this is some generally interesting information, but I would guess it speaks more about funding. I would wonder about reimbursement for Medicaid and Medicare. I think the questions is, really, are states doing a good job funding? Are they providing adequate services to their elders?"

Local Emphasis Encouraged

Corrigan emphasized that Worcester area residents should focus on just that -- the Worcester areas.

"Roughly 2/3 of nursing home residents in Massachusetts are there under Medicaid programs. In Worcester County, 73% (about 3/4) are reliant on the Medicaid system."

"There are a lot of choices for people in Worcester County. Politics is local - so are nursing homes. People don't need to worry so much about how Massachusetts ranks. The question is a lot more local than that. Make a decision that is based on your own research."