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Ratings dip at many nursing homes under tougher grading scale, but some meet the challenge

One in five nursing homes in Western New York received the lowest possible score in the latest ratings released by the federal government.

Not only did more facilities receive a 1-star rating compared with last year, but the ratings for dozens of others fell by one, two or three stars on the government’s 5-star scale.

The dramatic ratings drop came after the federal Centers for Medicare & Medicaid Services toughened the scoring system to measure how well the nursing homes care for their residents.

A Buffalo News analysis of the scores found:

• The share of Western New York nursing homes with a 1-star rating increased from 6 percent in 2014 to 22 percent this year. Statewide, the percentage of nursing homes with the lowest rating rose from 11 percent to 18 percent.

• The share of the region’s nursing homes with the highest, 5-star rating fell from 17 percent last year to 10 percent this year, a steeper drop than in New York State as a whole. The percent of the state’s nursing homes with the highest rating fell from 25 percent to 20 percent.

• The average overall rating for Western New York’s nursing homes fell from 3.3 stars to 2.8 stars, placing the region in the middle of the pack among the state’s 10 regions.

• Locally, the ratings for five nursing homes fell by three stars in the past year, while the ratings for four nursing homes fell by two stars and by one star for 22 other facilities. The ratings for 33 nursing homes did not change, and nine facilities gained a star in their ratings.

The government made it harder to achieve a 4- or 5-star rating because of growing concern that ratings in past years failed to reflect the quality of care at facilities.

“This is a terrific step,” said Richard J. Mollott, executive director of the Long Term Care Community Coalition in New York City, a consumer advocacy group.

The new ratings are more accurate, Mollott said.

“In the past, it was too easy to get four or five stars,” he said. “It’s still easier than it should be, but definitely better.”

About 80 percent of the nearly 16,000 nursing homes in the nation received either a 4- or 5-star rating last year. Only about one-half of nursing homes earned a 4- or 5-star rating in the new ratings.

The overall rating is based on annual inspection results, staffing levels and performance on 11 quality measures, like the percentage of residents who had urinary tract infections or reported pain.

The ratings can be found at the Nursing Home Compare, a government website that helps consumers evaluate nursing homes.

Federal officials cautioned that the lower scores – a result of the new standards – do not reflect a sudden decline in quality at many homes.

But nursing home representatives worry that consumers will interpret the lower ratings as a drop in quality rather than a change in the measurements.

“Nursing homes improved and reached targeted goals in the old rating system. It’s natural that you would reset the targets,” said Nancy Leiville, senior director of member operational support for the New York State Health Facilities Association, an organization for for-profit nursing homes.

The new standards were adopted to keep pace with progress made by facilities, she said.

“Nursing home quality has improved, and the government just ratcheted up the benchmarks,” Leiville said.

Lower ratings

Ratings fell by at least one star at 31 nursing homes in Western New York.

And 16 nursing homes received a 1-star rating under this year’s tougher standards, up from four in 2014.

Absolut Care of Dunkirk fell from a 4-star to a 1-star rating. Gowanda Rehabilitation and Nursing Center received a 1-star rating, down from a 4-star rating a year ago. Schoellkopf Health Center in Niagara Falls went from a 4-star rating to a 1-star rating.

Other nursing homes with a 1-star rating include Williamsville Suburban, Niagara Rehabilitation and Nursing Center in Niagara Falls, The Pines Healthcare & Rehabilitation Center in Olean, Erie County Medical Center’s Terrace View, Ridge View Manor in Buffalo and Absolut Care facilities in East Aurora and Orchard Park.

Fox Run at Orchard Park went from a 5-star to a 2-star rating. Odd Fellow and Rebekah Rehabilitation and Health Care Center in Lockport, a 5-star rated facility a year ago, is now a 2-star facility.

Nursing home administrators attributed the lower ratings to stricter standards for inspections.

Odd Fellow – an independent, 126-bed facility in eastern Niagara County – received a 3-star rating for its staffing level in both 2014 and 2015. But the facility’s quality measures dropped from a 5-star ranking to a 3-star ranking, and its health inspection rating fell from five stars to two stars.

Judy Waite, the home’s director of nursing, said a new survey team followed more stringent requirements during is visit in July.

“They really dig,” Waite said. “That’s their job. I understand.”

Odd Fellow also self-reported an incident in which an employee’s actions, or inaction, could have put a resident at risk, Waite said. No one was harmed. But Waite said she believes the case also hurt the nursing home’s rating.

Fox Run – a 50-bed skilled facility sponsored by the United Church Home Society – had an incident involving a resident that likely lowered its rating.

Michelle Murtha, Fox Run’s associate executive director, said she couldn’t offer details but said no one was injured in what she called an “isolated” incident.

Fox Run’s 5-star health inspection rating in 2014 fell to a 1-star rating in 2015, according to the Centers for Medicare & Medicaid Services.

“Fox Run provides the highest level of quality care,” Murtha said. “It’s just a shame that CMS gets this snapshot, and they don’t see what we do on a daily basis. So I would invite anybody to come in and spend a day at Fox Run and see what we’re all about.”

At Schoellkopf, inspectors cited 10 deficiencies in its last annual inspection and also a complaint inspection.

The deficiencies did not pose significant harm to residents.

“Quality is a moving target,” said Schoellkopf administrator John Durno. “It was the number of deficiencies, not their severity.”

He said Schoellkopf remains as good as it was a year ago.

“The rating system is not an accurate gauge. It’s just one piece,” he said. “You have to visit a place and talk to people who know about it.”

High ratings

The McGuire Group operates three of the seven facilities in the region with 5-star ratings: Autumn View Health Care Facility in Hamburg, Harris Hill Nursing Facility in Williamsville and Seneca Health Care Center in West Seneca.

“The government raised the bar and, for us, that is a good thing,” said James McGuire, the chief executive officer. “It will hopefully make everyone strive harder.”

McGuire welcomed the revised system, saying it helps distinguish his company’s nursing homes from the competition.

“There is no silver bullet to quality. It is the culmination of many things over a number years,” McGuire said.

“It comes down to the culture of the organization,” he said. “There needs to be a commitment from top to bottom. You have to give your staff the appropriate resources, the tools and the training.”

The region’s four other 5-star nursing homes are Briody Health Care Facility in Lockport, Elderwood at Wheatfield, Heritage Village Rehabilitation and Skilled Nursing in Gerry and the New York State Veterans’ Home in Batavia.

“When the state inspectors come, they are right there watching every move the staff makes, and even people who have been here a long time can get nervous,” said Ann Briody Petok, owner of Briody Health Care Facility.

She said admissions staff can tell when people calling about placement have “done their homework” about long-term care.

They’re looking at the ratings, she said.

Staffing concern

Staffing is a pivotal measure in the rating system.

Nursing homes self-report staffing data during a two-week period before their annual surveys. Advocacy organizations call the system easily gamed.

A Center for Public Integrity investigation last year found large gaps between staffing levels reported by nursing homes and levels calculated using the homes’ financial documents. More than 80 percent of nursing homes reported higher levels of registered nurse care to the Nursing Home Compare initiative than were reflected in their reports to Medicare, according to the organization’s analysis.

The Affordable Care Act required the use of payroll records to verify staffing levels. The deadline for that change was 2012, but it has taken longer to complete the new method for reporting staffing levels. The Centers for Medicare & Medicaid Services anticipate using payroll data in 2016.

“Staffing is the key to quality, probably the most important factor, and we need accurate information,” said Mollot of the Long Term Care Coalition.

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