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February 5, 2008

Report rates nursing homes on bed sores, restraints

The federal government today identified 12 Rhode Island nursing homes that have high rates of bed sores or use physical restraints excessively, saying these homes will be targeted for improvement over the next three years.

Kerry Weems, acting administrator of the U.S. Centers for Medicare & Medicaid Services, said the nursing homes on the list are not necessarily the worst ones in the state, because CMS considered only two aspects of care, and these homes may be doing well in other areas.

But Dr. Stefan Gravenstein, clinical director of long-term care at Quality Partners of Rhode Island, said that difficulty with restraints and pressure ulcers often signal more widespread problems in a nursing home, such as high staff turnover.

CMS listed two nursing homes as having problems with both physical restraints and pressure ulcers: Kent Regency Center, in Warwick, and Bethany Home of Rhode Island, in Providence. Haven Health Center of Coventry performed poorly on use of physical restraints.

The remaining nursing homes on the list had problems with pressure ulcers only: Epoch Senior Health Care on Blackstone Boulevard, in Providence; the Friendly Home, in Woonsocket; Harris Health Center, in East Providence; Haven Health Center of Pawtucket; Hopkins Manor, in North Providence; Jeanne Jugan Residence-Little Sisters of the Poor, in Pawtucket; Morgan Health Center, in Johnston; Pine Grove Health Center, in Pascoag; and Watch Hill Care and Rehab, in Westerly.

CMS released the list of low-performing nursing homes around the country this morning to add focus and accountability to the work of its quality-improvement organizations – private agencies hired in each state to improve the care of Medicare beneficiaries. These agencies will be required, over three years starting Aug. 1, to show measurable reductions in pressure ulcers (bed sores) and inappropriate use of restraints in some of the targeted nursing homes.

Quality Partners is the quality-improvement organization for Medicare beneficiaries in Rhode Island.

CMS also released a list of hospitals that performed poorly in measures to prevent surgical infections and that will face similar improvement efforts. But no Rhode Island hospitals made the list because hospitals in this state perform very well on those measures, said H. John Keimig, chief executive officer of quality partners.

-- Journal medical writer Felice J. Freyer

“All the hospitals performed well above the national average,” Keimig said. Keimig said that his agency would work for further improvements in Rhode Island hospitals and also focus on such issues as reducing infections with drug-resistant bacteria.

“Even though none of hospitals hit the list,” he said, “there’s opportunity for further improvement.”

CMS is pushing the quality-improvement organizations to bring about change in the nursing and hospitals, but nothing requires these providers to cooperate. Weems said that being publicly listed as low-performing “is incentive enough for them to improve.”

And in Rhode Island, said Keimig, the Health Department gives an added push. The state health director, Dr. David R. Gifford, was previously chief medical officer of Quality Partners, and the Health Department, which controls nursing home licenses and inspections, “can put some pressure on nursing homes to work with us,” Keimig said.

Although CMS came up with a list of 13 nursing homes (one of which has closed), it has not yet decided how much money it will pay for this effort. So Quality Partners is not sure how many nursing homes it will be able to work with, nor which ones, Keimig said.

Additionally, very small nursing homes may not have chronic quality problems but rather an issue involving a few patients that looms large percentage-wise because of the small number of residents, said Gail Patry, director of long-term care at Quality Partners.

In the case of the two smallest nursing homes on the list – Bethany Home, with 33 beds, and Harris Health Center, with 32 – Paltry said she had not analyzed the data to determine if their inclusion was a statistical fluke or a sign of trouble.

Gravenstein said the work on reducing pressure ulcers would involve not just the nursing homes but the hospitals where nursing home residents are often admitted, and where their bed sores may get worse. And for the nursing homes, he added, quality-improvement efforts often end up saving money.

-- Journal medical writer Felice J. Freyer

Posted by Andrea Panciera at 5:18 PM | Permalink

Comments

Please let me knoe of further finding at Bethany Home. Thank you

steve | February 6, 2008 10:25 AM link

Steve: You can go to medicare.gov and click on the nursing home compare link to get information on this home (how they did on their last surveys, etc.) and any others in any state.

Jo | February 6, 2008 12:21 PM link

Bed sores are evil. A disabled family member who lived with us for many years developed a terrible bed sore that none of us knew about. Apparently his primary physician knew, but must have shrugged it off. Eventually it became necrotic and had to be surgically removed. Over a period of years he racked up over a million dollars worth of medicare/medicaid bills as a result.

This push to keep seniors out of nursing homes has a terrible downside when simple medical issues like bedsores are not adequately addressed.

Evil bed sores | February 6, 2008 6:20 PM link

Do you really think that putting your family memeber in a nursing home would've prevented bed sores? They happen more frequently in nursing homes because there is one care-giver for several patients. You've been taking care on ONE family member for years and you couldn't prevent the bed sore.

m | February 7, 2008 11:59 AM link

February 5, 2008

Report rates nursing homes on bed sores, restraints

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