Nursing Home Rating System

  1. Since I work in Long Term Care, after reading these two articles I wanted to share them here and get some reaction to the iniative of creating a Data System to track Nursing Home operators. I have not read enough about the pros and cons of the issue to make an informed comment yet. But what I can say is that I have worked in Nursing Homes in Florida that did not have daily supplies available to give quality care. I have worked a med cart without spoons or cups, I have had to go to the store to buy juice for the diabetics because the kitchen had none and I did not have a keyy to get into supply (if there was any) The CNA's would have to horde diapers for each other under residents mattresses because the next shift would have none (they were looking out for each other and the patients) Bills were not paid, routinely your meager pay check would be short (I believe this was purposely done because they did not have the monies for payroll)
    Anyway give me your feedback and if so inclined email this legislator.
    The quote from the operator in Texas and his Lawyer deserves bricks "His lawyer, Randi Nathanson of Seattle, said Lemon “doesn't feel he needs to explain anything because he is getting out of the nursing home business.”

    Nursing home operator's poor record wasn't caught in Texas

    DALLAS — Nursing home operator Rocky Lemon acquired 21 homes in Texas in less than a year, despite his track record of troubled homes in Oklahoma.

    Now the state is left holding the bag, after spending $2.4 million to take over 14 of the homes and move residents to other facilities. State officials say Lemon failed to pay employees, buy food and provide adequate care.

    Many of the problems that led to the April takeover mirror those at homes run by Lemon before he came to Texas in 1998, the Dallas Morning News reported in Wednesday editions.

    Homes operated by Lemon in Oklahoma had unpaid bills and records of poor care dating back to 1995, according to government records. Lemon also has run nursing homes in California and Missouri.

    Lemon, 38, who lives in Los Angeles, faces a criminal trial in August in West Texas on a felony charge of injury to an elderly person stemming from his operation of Crane County Care Center.

    He owes vendors hundreds of thousands of dollars, and he faces civil charges of Medicaid fraud in Texas and in California. Last week California authorities accused him of neglecting 100 residents in four homes.

    Lemon once controlled more than 45 nursing homes through companies including TLC Health Care and Crescent Care. His lawyer, Randi Nathanson of Seattle, said Lemon “doesn't feel he needs to explain anything because he is getting out of the nursing home business.”

    In Texas, officials said the state does not have a way of flagging financially troubled homes before they reach a state of crisis.

    “This can happen again, because right now the system is not set up to catch financial problems until a facility has cratered,” said David Bragg, an Austin attorney and recognized expert on nursing home regulation.

    Jim Lehrman, Texas' deputy commissioner for long-term care, said other states don't always provide reliable information and that some nursing home owners including Lemon operate through multiple corporate identities to mask their past problems.

    At the 14 homes seized from Lemon, state officials spent April and May replacing nursing staff and moving 347 elderly and disabled residents. Four facilities were closed. New operators have taken over the rest.

    Applicants for Texas nursing home licenses are supposed to show a history of compliance with state and federal regulations. In applying for his first license, Lemon acknowledged problems in Oklahoma, but minimized them, records show.

    Texas has taken steps to improve its background checks of nursing home operators, but those steps have fallen short, advocates and officials say. Lehrman, the state's top nursing home regulator, said the system is still largely one in which operators decide what to disclose.

    What's needed, he said, is a centralized database that would include the performance records of all operators and facilities in the United States.

    Now, operators “can leave one state and set up in another with a seemingly clean record,” said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

    article: Ran on CNN
    U.S. considers system to rate nursing homes
    June 6, 2001 Posted: 10:21 AM EDT (1421 GMT)



    WASHINGTON (Reuters) -- Health and Human Services Secretary Tommy Thompson said Tuesday his department was considering creating a ratings system to inform Americans about the quality of nursing homes and other Medicare providers.

    Thomas Scully, who heads the Health Care Financing Administration (HCFA), which oversees Medicare, Medicaid and other government health insurance programs, told a business group Monday the Bush administration planned to begin a ratings system to allow consumers to have unbiased information with which they could make choices about their care.

    Thompson said a ratings system was under consideration, but did not say a final decision had been made. HCFA is an agency within Thompson's department.

    "I'm going to have a press conference within the next 10 days outlining the changes that I intend to make at HCFA (and) talk to you about a ratings system," Thompson told reporters. "Mr. Scully got a little bit ahead of himself."

    The plans Scully mentioned were for the government to provide numerical ratings of the quality of care given by nursing homes, dialysis centers, and perhaps in the future, hospitals and doctors. Under that plan, the ratings for all providers under the Medicare health care program for the elderly and disabled would be made four times a year.
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    About Chellyse66

    Joined: Oct '00; Posts: 156; Likes: 9
    R.N. Long Term Care


  3. by   rncountry
    Hey Michele!
    This is good to ponder, I would like to see something like this, though I have to say everytime HCFA does something it seems to increase the paperwork nurses do somehow! Be interesting to see how this pans out. I hope Rocky there goes to jail for a long, long time.
  4. by   Tim-GNP
    Texas has always been sloppy with their licensure requirements and enforcements. Where I come from; if you get 3 "G" level deficiencies [substandard care quality], the Board of Examiners of Nursing Home Administrators calls you to appear before them to answer why.

    The unfortunate thing about this is that one study that I read suggests that there is an approximate 50% mortality rate associated with nursing home closure and mass relocation of frail institutionalized elders within the first 6 months.

    They shouldn't just throw the book at this clown--- they should beat the hell out of him with it!
  5. by   NRSKarenRN
    Nursing Home Inspection Results available at

    Nursing Home Compare
    Welcome to Nursing Home Compare. The primary purpose of this tool is to provide detailed information about the performance of every Medicare and Medicaid certified nursing home in the country. Important Information on Nursing Home Compare and other resources, including the Guide to Choosing a Nursing Home, and Nursing Home Checklist are also available to help you with your nursing home choice.

    Begin Nursing Home Search

    Nursing Home Compare contains the following sections of detailed information:

    About the Nursing Home: including the number of beds and type of ownership.
    About the Residents of the Nursing Home: including the percent of residents with pressure sores, percent of residents with urinary incontinence and more.
    About the Nursing Home Inspection Results: including summary results from the last state nursing home inspection.
    About Nursing Home Staff: including the number of registered nurses, licensed practical or vocational nurses, and nursing assistants in each nursing home.

    Search is done via state then county areas. I was able to review all LTC facilites in my area. Statistics are only here available for facilities with Medicare or Medicaid funding, not for those that are private pay only.

    [ June 18, 2001: Message edited by: NRSKarenRN ]
  6. by   maryb
    Unfortunately, I've been to that web site and looked at the postings. It is apparently subject to political pressure. A local nursing home (in which I was formerly employed) underwent state inspection last year and received 23 serious violations. The facility was closed to admissions. This inspection was never posted. The third follow up inspection (which they passed) was finally posted.
    I'm left wondering what other facilities have this type of violation that is never "publicly" reported.
  7. by   BeBeSweet
    How's this for political pressure.The company i work for was awarded a "private' contract to take over management of a very prominant state facility a few years back.Lot's of controversy in the papers and on the news about it. When it came time for my facility liscensure inspection, we were handed a near perfect inspection, even though those of us working there knew better and were sweating out a possible substandard care tag.I guess they couldn't hand out deficiency tags to a company who was supposed to be in the better interest of the state residents.These excellent surveys were seen throuighout the state. Makes one wonder
  8. by   Barbara Rose
    Well, the nursing home behind my home was one of the "Lemon" homes closed. Another one in town was sold in the 11th hour, 7 pts. have died from the trauma that we know of, and that doesn't count the ones we don't know about, the ones that were displaced out of our immediate area, and the ones without family. Also, that doesn't address the many employees who are now unemployed, and didn't get their paycheck until way after pay day, causing financial burdens for those who only make a barely existable living anyway. The state appointed trustees are also being questioned and investigated because of family and resident complaints. It has been horrible. Now, there are other problems in this industry, I have over 20 years experience in LTC. I have worked with the OIG on a case against a chain, I have seen them come and go, and I have seen good and bad. I have also seen the survey work well and be tainted. It depends on who your surveyors are and who owns your building at the time. It doesn't seem to matter whether the care is good or bad, you and I Michelle know that on any given day you can find something wrong in any nursing home if you look. What is the answer? I am not sure that the federal government can solve this problem, it will have to come from local communities and states. If more people are involved, then the accountability goes up. Even after all these problems here in town, we tried to get folks to a Texas Advocates for Nursing Home Residents meeting, only 4 showed up, including me and I not only advertised the meeting but spoke before several local groups as well as one of the other members. Apathy is a big problem, but then, isn't it the same in the entire health care arena, including nursing these days? Sorry if this seems sour, but I have been very disgusted lately myself and have found that "the system" can really work against you even when you are trying to do better for the entire body. What gives? What are the answers? Will we ever find them?
  9. by   maryb
    Unfortunately, getting people involved is an uphill battle on a good day. Just look at the state of nursing. Especially when the facility really is a good one, by comparison. I've worked in two different long term care facilities in the area, and the differences are unbelievable.
    The first one, we never had supplies or adequate staffing, and to say that the residents received inadequate care was a major understatement.
    The facility that received the 23 violations was light years better. We always had the supplies we needed, and patient care was (barely) adequate. It was not, however, as good as it could have been with adequate staffing.
    The problem remains one of politics, I think. The facility has major connections, and none of the violations, a patient death due to restraints, and a staff fight that involved throwing a chair out a patient's window was ever reported in the local papers, even though this happened during a time when one of the local papers was supposedly doing an "expose" on local long term care facilities.
    A month ago, an unknown infection went through the facility, resulting in pneumonia in something like 50 residents. The CDC was called in, etc. Things finally got back to normal, but not a peep in the local press, even though the facility was under quarantine for a little over a week.
    So, the question is, how do we fight problems with staffing and inadequate care given the "political connections" of some of the larger health care organizations? I can't be the only one who really doesn't have a clue where to start. Any ideas on how to get the news out? On how to get the local media to do their jobs in reporting the truth about staffing levels and what constitutes adequate care?
    Barbara Rose, I think long term care leads to disgust in most nurses that work the area. And how do you change it? Like you, I have to wonder if we will ever have any answers.
  10. by   rncountry
    We will Barbara Rose, we will. It is not going to be a short term thing, it is going to take some very committed people, but we will. I have to believe that. I know where you are coming from. I have been there. But chin up, you are doing a wonderful thing, and eventually there is going to be changes. And this time it is going to come from the nurses that see if every day. It has to and we will be a part of it. Uphill maybe every step of the way, but there is a dedication on the part of many good nurses to make it happen. I say lead, follow or get out of the way! Glad to have you on my side Barbara.
  11. by   natalie
    Wanted to bring your attention to this site that a nurse named Louise has. She's in Massachusetts and posts nursing homes with atrocious histories on it. Her email link is at the end.