In a new nursing home ranking system by the federal government, 23 percent of Kentucky's 287 nursing homes ranked "much below average" while 10 percent were "much above average."
Medicare's new online ratings, available at www.medicare.gov, give consumers a way to compare the quality of care in nursing homes, based on state inspection records, staffing and other measurements.
Kentucky ranks just slightly below the national average — 22 percent of the nearly 16,000 nursing homes in the U.S. received the lowest rating in the five-star system. Nationally, 12 percent received the highest ranking.
"It will take time to evaluate how well the rating system reflects residents' actual experiences with nursing homes," said Sherry Culp, director of programs and services for the Nursing Home Ombudsman Agency of the Bluegrass Inc.
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Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said the agency was merely taking existing data and making it easier for patients and families to evaluate a nursing home. He said it can be difficult for people to understand all the aspects of an inspection.
Federal officials, nursing home industry officials and advocates all said Thursday that the best way to choose a nursing home is by visiting it and that the rating system should not be the sole factor in any decision.
The ratings are based on three key elements of quality — quality measures, surveys and nurse staffing.
Under the new system, five stars is the highest ranking, with four stars indicating "above average;" three meaning "about average;" two, "below average," and one, "much below average." The rankings will be updated quarterly.
Reactions from representatives of the nursing home industry were mixed Thursday.
Tim Veno, president and chief executive officer of the Kentucky Association of Homes and Services for the Aged, said he was in favor of the openness and simplicity that the federal government says the rating system will bring.
"However, I think that they rushed to put out a system that is misleading to the public," Veno said.
For example, Veno said that because of flaws in the system, homes that have sicker patients might get a lower score through no fault of their own.
But Bernie Vonderheide, president of the advocacy group Kentuckians for Nursing Home Reform, called the system "a historical breakthrough in monitoring nursing home quality and at last a victory for the thousands of forgotten Kentuckians in nursing homes."
Culp said her advocacy group is pleased that the federal government is making more information available to the public.
And, she said, the rating system for the first time provides a national nurse staffing standard, calling for each resident to receive 4.08 hours of nursing care each day.
But Culp said she was concerned that the staffing data is self-reported and is widely recognized as unreliable. Advocates want the federal government to collect nurse staffing data electronically from payroll records, she said.