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Prairie Village, KS – For more than a decade, the non-profit Kansas Advocates for Better Care, or KABC, has released an annual report detailing the best and worst performing nursing homes in the state. The findings are based on state inspections over a three year period (the inspections occur once every 12 to 15 months).
In KABC's latest report, only about five percent of nursing homes in the state showed positive inspection trends, meaning they were consistently cited for five or fewer deficiencies. One of those places was Claridge Court, a continuing care retirement community in Prairie Village.
KCUR's Elana Gordon recently stopped by there and spoke with the health center's director, Chris Anderson, as well as KABC's Executive Director, Mitzi McFatrich, about the report and about what families can and can't learn from it.
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GORDON: Overall, what did you find in nursing home ratings in the state?
MCFATRICH: I think there's a real range of care and performance that happens in Kansas, like there is in every state. One of the things we noted in the most recent performance trends on health inspection surveys is that in Kansas, there are some homes that have no deficiencies cited during the inspection process, and some that have as high as 53. On the good side, that's down from the last couple of years when the high was in the seventies as opposed to 53. But it's disturbing to me to know that 92 facilities in the last year were cited with actual harm, or immediate jeopardy - that 40% of facilities in the state of Kansas were cited with deficiencies related to abuse, neglect, or exploitation.
GORDON: What do you think some of the challenges are that lead into around 90 nursing homes having these situations?
MCFATRICH: Well, I think the things that have been documented, both in terms of research and in talking to residents, are things like lack of consistency of leadership, lack of good leadership, lack of adequately trained staff. Sometimes it comes because staff doesn't always serve the same resident and they don't know enough about the resident. They're not able to keep up with the health changes that a resident might have. I think there's a clear problem with being able to keep staff in nursing facilities for long term and, from my own experience having taken care of both my parents in their end of life and dying process, it's hard work. And so I think all of those things come together to create situations where facilities aren't performing at the level we would want each and every person who lives in a nursing home to be receiving.
GORDON: How are nursing homes, or to what degree are they monitored?
MCFATRICH: They have a survey from the state of Kansas. They come in and they're inspected both by a team of nurses and also by the fire marshal just for basic health and safety issues. Over the last three years, the Kansas Department on Aging has increased the length of time between surveys. Three years ago, it was running just about every 12 months. Now it's running just about right at 15 months. And I know that has happened in part because of loss of revenues to the state, budget cuts, and not filling surveyor positions, holding those positions open, not having as much staff to do the inspection surveys. In addition to that, if there are concerns that residents or their families raise, there's an opportunity to make a report to the Kansas Department on Aging, and they have a process by which they can send surveyors in between the annual survey, or every 15 months survey process. And there's also a terrific program called the ombudsman program that is a state program mandated by the Older Americans Act. And they are mediators and negotiators for resident concerns with the facility - or with their family or whomever the concern is with - on behalf of residents who live in facilities in the state of Kansas.
GORDON: So, each year the Kansas Advocates for Better Care releases this report of how nursing homes are doing in the state - as far as some of the ones that have gotten the best scores and some of the worst. What information went into coming up with the list?
MCFATRICH: Each year, we do this poor performance trend and positive performance trend and we base it exclusively on the information that comes out of those health inspection surveys that each nursing home in the state of Kansas goes through every 15 months. We use five or fewer deficiencies cited for nursing homes that are on the positive performing trends, and we also eliminate any nursing homes that would receive a higher serious deficiency in those five or fewer - so if someone's cited with actual harm or immediate jeopardy, they aren't going to show up on the positive performance trend list, even if they have five or fewer deficiencies. And, for those who show up on the poor performing trends, as with the positive performing trends, we're looking at a three year period of performance and we are looking at facilities that have ten or more deficiencies over each of those three most recent surveys (so that might be longer than three actual years because the survey happens every 12 to 15 months).
GORDON: Chris Anderson, you direct Claridge Court. In looking at these reports of nursing home ratings over this three year period in this end of year report - there's a lot more nursing homes that have received several citations than the seven places that didn't receive any. And one of those places was Claridge Court here in Prairie Village - which is where we are. How do you feel that Claridge Court's been able to do this?
ANDERSON: Kind of what sets us aside from the free-standing long term care facilities is because of our life-care concept within our non profit retirement community, we're able to provide a little bit better staffing than maybe most facilities are in the community.
GORDON: Why is that?
ANDERSON: Because we are primarily Medicare certified and private pay, so our census mix gives us an opportunity to have more resources for care and services for our residents. The most important aspect, though, is what we talked about earlier - the (lack of) staff turnover. That makes a huge difference in quality of care and services with the residents.
GORDON: Do you think that the Medicare rating system, as well as these reports by Kansas Advocates for Better Care, are good reflections of what's going on in nursing homes and a way for people to identify what are good places?
ANDERSON: I think it's a good piece of the puzzle. It's a tool to use. But it's not one tool that a person should use. The number of violations in a nursing home - it's important to look at what violation they are. Because you can have some violations that are as obscure as nursing homes are required to post the surveys for the year. But if the nursing home doesn't have a magnifying glass with that book, that's a violation. So it's a good tool to use, but it's important to look at every aspect.
GORODN: So what are some things in particular to look for - how do you know if a nursing home is good or not?
Tour the facility unannounced. Come at different times throughout the week, the weekend. So really when you walk in, you're seeing a brief picture of the home at that time. Does it have an odor? Does it not? Do residents look clean? Do they look happy? And more importantly, watch the staff interaction with the residents. That's going to really give you a brief glimpse at the services being provided.
GORDON: Mitzi, you've been noting your head a lot during this.
MCFATRICH: Well, I think there's the care side and there's the business side, and they both impact each other. Some of the things we tell people when they call us ask are has the management been consistent? Have they been owned by a number of different ownership companies? Is it a national chain? Is it a local company? There are positives and negatives on both sides of that equation. Has the director of nursing been there consistently? Is there a consistent staff? And not only has that staff been there, it is a highly trained and well-functioning staff? Is there a lot of turnover? In the old days we would say, and sometimes we still do, is there lots of outdoor light? Is it easy to navigate? Are the hallways well lit, are the rooms pleasant.
GORDON: Both of you have had experiences in long term care from a very early age - what have you noticed being some of the shifts in nursing homes?
ANDERSON: One of the important aspects of long term care that's changed in the last ten years or so is really the concept of culture change. That if - really giving that residents that opportunity to have more choice in their care and services. Which years ago in long term care, you came to a facility, they told you when you're going to get up, when you're going to eat, when you're going to get a bath, when you're going to go to bed. And that whole concept is broken. And it's changed in the last ten years.
MCFATRICH: I think the trend is going in the right direction. Obviously, I don't think the change is happening quickly enough or pervasively enough to really create the kind of choice and good care environments that all of us want to find ourselves and our loved ones in. There are so few facilities that are on a positive trend in terms of the inspection survey process, and there are so many on the negative inspection trend in the survey process. I'd like to see it go in the other direction. I'd like to see over 70 facilities, or over 300 facilities, on the positive performing list and it really be inverse in the other direction.
GORDON: Mitzi McFatrich, director of the Kansas Advocates for Better Care, and Chris Anderson, Director of Claridge Court Health Center, thanks for speaking with me.
MCFATRICH: Thank you.
ANDERSON: Thank you.
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