January 11, 2018 / 12:08 PM / a year ago

COLUMN-Shopping for nursing homes more tricky in Trump era

 (The opinions expressed here are those of the author, a
columnist for Reuters.)
    By Mark Miller
    CHICAGO, Jan 11 (Reuters) - Finding a safe, high-quality
nursing home for a loved one is never an easy task. Complicated
decisions often are made at a moment of emotional crisis and
reliable guidance can be difficult to come by.
    And it is going to get more difficult. The Trump
administration is moving quickly to deregulate nursing homes,
complying with a wish list submitted by industry lobbying
groups. Consumer advocates worry that the changes will lead to
deterioration in safety and the quality of care delivered to
some of the most vulnerable Americans.
    Just before the holidays, news broke that the Trump
administration is curtailing the use of penalties against
nursing homes that harm their residents or put them at risk of
    The story, first reported in the New York Times (nyti.ms/2EcObyR),
 is just the latest in a series of rapid-fire moves by the
Centers for Medicare & Medicaid Services (CMS) to loosen, delay
or strip away regulation of nursing homes.
    In November, CMS exempted nursing homes that violate new
patient safety rules from financial penalties for 18 months. In
June, it proposed to reverse an Obama administration rule
prohibiting clauses in residents’ contracts requiring them to
use arbitration to settle disputes rather than go to court.
    “The industry sees this administration as a real golden
opportunity to get what it wants,” said Toby Edelman, senior
policy attorney at the Center for Medicare Advocacy (CMA), a
nonprofit group that provides Medicare-related education,
advocacy and legal assistance to seniors.
    CMS has broad authority to regulate nursing homes that
accept patients covered by Medicare and Medicaid - virtually all
nursing homes in the United States. Its recent moves will take
an industry where enforcement of rules has been weak, and make
it weaker still, Edelman argues.
    Nursing homes subject to the Obama penalty rules generally
were limited to those suspected of harming residents or placing
them in immediate jeopardy. The repeal of CMS guidance in this
area will leave even these nursing facilities facing looser
    Nursing home choices often are made during stressful times
for families, when a patient’s hospital stay is ending and the
shift to a skilled nursing facility is imminent. That leaves the
door open to rapid, emotion-driven decision making. “So don’t do
that,” urged Robyn Grant, director of public policy and advocacy
at the National Consumer Voice for Quality Long-Term Care.
    “It’s really a good idea to do a little research before a
crisis emerges,” she said. “If something happened to me or a
family member, where do I want to go?”
    Unfortunately, information rating the quality of nursing
homes is spotty. A good starting point is Medicare’s system for
rating nursing homes for quality of care and staffing levels,
called Nursing Home Compare (bit.ly/1CHwbuM). The system
rates nursing homes on a scale of 1 to 5 and is considered the
industry authority. 
    But much of the data that determines ratings is
self-reported by nursing homes, and the ratings do not take into
account negative information such as fines and enforcement
actions by states. And reviews of this system have found
numerous cases of facilities attempting to “game” the system.
    One study published last year of California nursing homes
between 2009 and 2013 found inflated star ratings. Forty percent
of the facilities received four or five stars in 2009, but that
had risen to 60 percent in 2013. The researchers found little
correlation between the ratings and actual health inspections by
state regulators.
    Nursing home shoppers also should consult Nursing Home
Inspect, an online database created and maintained by
ProPublica, the nonprofit investigative news service (bit.ly/2mh8SCC).
 The database contains state-by-state breakdowns displaying
fines and deficiencies turned up by inspections, and it flags
nursing homes with histories of serious quality issues.
    Grant recommends checking on any facility you are
considering with your state’s long-term care ombudsman, a
program administered by the Administration on Aging. Consumer
Voice offers a directory of state ombudsmen on its website (bit.ly/1I1SgDp).
    A trusted physician also can be a good resource, she said.
“Ask them about experience with facilities. Ask a trusted
doctor, 'What facilities would you go into if you needed one?'”
    She also recommends checking with friends who have had
experience with facilities under consideration. Geriatric care
managers - human service professionals who help coordinate care
for the elderly and their families - also can help navigate the
nursing home maze.
    But consumer vigilance is an incomplete response to the
rollback of regulatory protections now under way. “We’re talking
about one of the most vulnerable populations in the country -
many don’t have family living nearby or don’t have family
members at all who can look out for them,” Grant said. And CMS
data shows that 61 percent of nursing home residents in 2014
suffered from moderate or severe cognitive impairment, which
means many will struggle to look out for their own interests. 
    “If you are concerned about the quality of care in nursing
homes now, you have no idea what will happen if we take away
these protections.”

 (Editing by Matthew Lewis)
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