Quality care in skilled nursing: Is it possible?

Thu Mar 28 2019

By Carrie Pratt, Administrator, Focused Care

First, you make the decision, presumably based on the recommendation of the physician treating you or your loved one, that skilled nursing care is needed. Second, you may panic and wonder how you decide where to receive short term rehab or skilled nursing care. A hospital discharge planner may make a recommendation – but what is that based on? Is the long term care community closest to the hospital the best place or maybe the one closest to home? How do you know what to do next?

Every year the Centers for Medicare and Medicaid (CMS), the federal agency responsible for rating quality of care, updates and announces the Five-Star Quality Rating System that ranks the performance of skilled nursing facilities to help consumers, their families, and caregivers compare nursing homes more easily. The CMS determination is based on three categories: Health Inspections, Staffing and Quality Measures (QMs). Nursing homes with 5 Stars are considered to provide above average quality of care and nursing homes with 1 star are considered to deliver quality care much below average.

The 5 Star rating is independent of any local marketing by an individual long term care community and adheres to a very complicated series of methodologies confusing enough to puzzle a rocket scientist, let alone the average consumer. But what it tells folks in the market for skilled nursing care is how a particular facility performs statistically in these three very important areas. It might be used as a screening tool in the process of having to make that difficult decision.

The rating system also lists states in an order that reflects how their facilities fare in the area of quality performance. This year, as in past years, Texas came in last. What the rating system doesn’t take into effect, is state specific laws and regulations that greatly impact the skilled nursing care sector. For example, Medicaid beneficiaries make up roughly two-thirds of the patient population in skilled nursing communities – pretty much across the 50 states. State legislatures set the Medicaid rate per beneficiary – so that number is different in every state. In Texas, there has long been a substantial deficit in the set Medicaid rate verses the actual cost of care. This year, the Texas Health Care Association notes skilled nursing facilities are reimbursed $27 less per patient per day than the calculated cost of providing care to a range of residents, many with increasingly complex conditions.

The same apples to oranges comparison can be found in the regulatory environment. State regulations for health care providers – all kinds – differ. Those states that log in fewer deficiencies for long term care facilities aren’t necessarily the states with less regulation – they may just have more effective regulation.

So regardless of the state you happen to live in, can a skilled nursing community attain a 5-star rating?

The answer is – yes. It is indeed possible to provide high quality care in a skilled nursing community no matter how difficult the political and policy-making climate. The recipe for achieving that requires strong, professional leadership, smart hiring principles, an overall expectation of excellence by every staff member who walks through the doors to start a shift, attention to guest services and needs, and a commitment to improving health outcomes and making a patient’s stay meaningful.

Skilled nursing care is a people-intensive form of health care delivery. There are people who chronically let responsibilities fall through the cracks and those people have to go. There are also people who believe that maintaining the dignity of their residents matters, that it is important to be mindful of their residents’ concerns and needs, and that their job is a mission shared by their team members.

Health care policy and regulation have tremendous influence over the ability of long term care providers to provide the best care to seniors. But with all of that, it really comes down to people taking care of people. Providing the best patient-centered care requires having the best people to deliver it – that’s a winning team.