An alarming 30 percent of the nursing homes in Greater Cincinnati and Northern Kentucky are woefully below average, while just 12 percent earn top ratings, according to a new national rating system.

An Enquirer analysis reveals that the proportion of low-rated nursing homes in the region is higher than the national average of 20 percent. On the positive side, the local proportion of top nursing homes exceeds the U.S. average of about 10 percent.
 

The system gives each nursing home a star rating. Five stars is best, one star is the worst.

The data assess nursing homes in key categories: health inspections, number of nursing staff and other measures such as quality, patient satisfaction and general well-being.

The data used to compile the ratings have been collected by the federal Centers of Medicare & Medicaid Services for decades. Until now, the information has never been so easily accessible to the public, said center spokeswoman Mary Kahn. “We just hope the nursing homes will take this information and use it to improve,” Kahn said. “Mostly, the new system is targeted at consumers to help them choose a nursing home.”

The data also show nursing home quality doesn’t depend on location, size or ownership.

In fact, some facilities that offer fancy perks score lower than others that offer limited extras – like Heritagespring in West Chester Township, owned by for-profit Carespring Health Care. Seniors in the Barrington assisted-living apartments can visit an on-site movie theater, restaurant or spa, but the nursing home portion of the facility got a one-star rating.

Rating critics, including some operators of nursing homes that scored poorly, say the system’s value is limited because it has too much room for human error. Many operators say the data shown on the Web site are not correct, but aren’t sure if it’s their own staff that submitted data incorrectly or if it was inserted erroneously by Medicare staff.

Nursing home ombudsman Mary Day of Pro Seniors, a nursing home watchdog group, agrees there may be reporting flaws. Even so, the system gives a fairly accurate picture of some of the problems with nursing home care, such as whether staff consistently provide required levels of care.

“The laws haven’t changed much,” Day said. “Do (nursing home operators) have a lot of hoops to jump through? Yes, but they are the same hoops.”

Bad reviews

The Arbors at Milford, Mount Pleasant Retirement Village in Monroe, Eastgate Health Care Center in Union Township, Montgomery Care Center and West Chester Nursing & Rehabilitation Center were the lowest rated nursing homes in Greater Cincinnati.

The homes received an overall one-star rating and scored below average in all three categories.

For example, more than 30 percent of the long-term residents at The Arbors were reported to have urinary tract infections. That’s much higher than the national average of 9 percent and the Ohio average of 11 percent.

The Arbors, a 139-bed facility, also chalked up 39 health deficiencies in its last inspection, including one for not notifying family members when a resident’s declining health conditions required sending the resident to an emergency room. The highest number of deficiencies in the state of Ohio was 55, while the average is seven deficiencies.

“We were disappointed by our most recent survey results and took immediate measures to correct the issues identified by surveyors,” said Mark Ostendorf, facility administrator for The Arbors. “The citations were low in scope in severity and all the citations were corrected and cleared by the Department of Health. There was no cited harm to any resident.”

The Mount Pleasant nursing home was found to have 14 health deficiencies in an inspection during September. One was a high-level citation, earned after a resident spilled hot coffee on himself. The resident was not supposed to be left alone to eat, according to the health inspection.

“We are disappointed in those results and we will do everything we can to try to get better scores,” said Dan O’Connor, chief operating officer for Ohio Presbyterian Retirement Services, the nonprofit group that operates Mount Pleasant.

In fact, the owners replaced some staff before the ratings were released, O’Connor said.1028b_top

Among the surprises: a two-star rating for the Drake Center in Hartwell, a facility known as one of the region’s most advanced long-term rehabilitation centers, and a one-star score for the Otterbein Retirement Community in Lebanon, the largest nursing home in Southwest Ohio with 296 beds.

“We feel we deserved better,” said Rosemary Cicak, vice president for marketing and public relations for Otterbein. “We invite anyone to come and see Otterbein and talk to the residents any time. We are really proud of our community.”

Cicak said she did not know details about the 16 deficiencies documented at Otterbein between September 2007 and November 2008, including one that affected 98 residents for mismanaging residents’ money. Otterbein mixed residents’ money in with facility funds, such as the “Sunshine funds” that pay for funerals or illnesses of other residents.

Cicak also said nursing homes can lose points if they have higher-than-average numbers of patients with declining conditions. Otterbein has a substantial amount of residents with Alzheimer’s and senior dementia.

“That has a huge impact on some of the ratings,” Cicak said.

In Northern Kentucky, there is just one five-star facility in Boone, Campbell and Kenton counties. That’s St. Luke Hospital East in Fort Thomas, and it has only 16 beds. Six of the 15 nursing homes in Northern Kentucky got just one star.

That includes Baptist Convalescent Center in Newport. It’s the only facility in the region on a “special focus facility” list, a list of nursing homes “that have a history of persistent poor quality of care,” according to the ratings system.

These facilities are visited twice as frequently by health inspectors than other homes. The longer problems persist, the more likely that monetary fines will be taken from the facility.

However, managers say Baptist Convalescent is improving. In 2008, the center had seven health citations, down from 26 two years ago.

Robert Long, of the corporate office, said he’s frustrated with the new rating system.

“Bottom line, these things are supposed to be objective scores,” Long said. “But they do subjective things.”

For example, once a nursing home is labeled a special-focus facility, there are limits to how high its scores can be in the next follow-up rating, he said.

View from the top

Located in the small town of Bethel in Clermont County, Morris Nursing Home doesn’t look like much.

But the for-profit, 18-bed facility is tied for the best score in the region, and has a waiting list to get in. In the past three years, the Morris home has received just seven low-level deficiencies, like one received when a nurse did not take a male resident for his daily trip outside.

The home has a long history in Bethel, opening in a white Victorian house in the early 1900s, now twice expanded.

Residents love the concrete patio that overlooks a cemetery and having a cook who will make special orders for breakfast, said Mary Leggett – known inside the facility as “Queen Mary.”

Leggett has worked as Morris’ health service supervisor for 22 years.

The Morris home is exactly where Leggett said she wants to go when she gets too old to care for herself.

“We aren’t the most cosmetically pleasing facility, but I don’t think that matters,” said Administrator Nicole McCaughey.

It’s the care the counts, McCaughey said. They can offer high quality because the facility is small and the staff members – all the way up to the father-son team that owns the home – take their jobs very seriously, McCaughey said.

But big, for-profit facilities can do well, too. Hyde Park Health Center, a nursing home on Rosslyn Drive with 170 beds, earned a five-star rating.

No facility in Greater Cincinnati got a perfect five-star rating – meaning an overall five-star average, plus five stars in all three sub-categories.

Four facilities, including Morris, tied for the best ratings in the region: Berkeley Square Retirement Center in Hamilton, Hillandale Health Care in Fairfield Township and Franklin Ridge Health Center in Warren County. All four currently have a five-star overall rating, plus a five-star in one sub-category along with four stars in the other two.

How to choose

Mary Day has helped people trying to find the right nursing home for 14 years.

But that’s just part of her job as managing ombudsman of long-term health-care facilities in Southwest Ohio – including Butler, Clermont, Clinton, Hamilton and Warren counties.

Federal law requires all nursing homes to have ombudsmen who drop into nursing homes to make sure they comply with state and federal laws, Day said.

The Southwest Ohio ombudsman group is called Pro Seniors. The agency cannot enforce or punish the facilities, but it works with local health departments that can.

Should people feel alarmed that 30 percent of the nursing homes in our region got one-star ratings?

Day hesitated. The ratings can reflect clear problems, such as inadequate staffing or frequent violations during inspections. But sometimes, the nursing homes lose ground in the ratings because of paperwork problems.

“I think we should use the (data), but then find out why they got that rating,” Day said.

“Is documentation an issue? Or are they not following procedure?”

Overall, the Medicare/Medicaid Web site is a powerful tool, but it should not be the only way that people judge nursing homes. You’ve got to visit, Day said, and do a “gut check.”

“It would be nice if we could go to the Web site and it could all be handed to us, but no regulatory system can do that,” Day said. “You should not discount what you observe.”

By Carrie Whitaker • cwhitaker@enquirer.com • February 1, 2009

 

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