By William J. Beerman, Sr.
“One Star — Much Below Average.”
That’s how the U.S. Government rates three of the six government-certified nursing homes in Las Cruces, a city of 102,000 and the second largest city in New Mexico.
The three Las Cruces nursing homes rated One-Star on the Medicare.gov Five-Star Rating System contain 66 percent of the 514 Medicare- or Medicaid-certified nursing home beds in the city. (Not from Las Cruces? Look up your city with the steps outlined below.)
Frequently, hospitals abruptly tell families to find a nursing home right away when their loved one is being discharged. So, what if an unprepared family in Las Cruces who has just gone through a medical emergency — such as a parent or spouse breaking a hip — gets rushed to find a nursing home without receiving sufficient guidance? If that happens in Las Cruces there is about a two-out-of-three chance that the patient will end up in a “Much Below Average” nursing home.
About 278 people are staying in Las Cruces’s One-Star homes today, according to the Federal Government.
Thanks to a recent rule change by the Centers for Medicare and Medicaid Services (CMS), the odds against a patient unintentionally ending up in a sub-par, inappropriate, nursing home may be about to improve.
Effective November 29, 2019, CMS will begin requiring hospitals to provide discharge planning information to families about quality factors pertinent to their nursing home choice.
CMS issued a final rule September 26 that empowers patients preparing to move from acute care (hospital) into post-acute care (PAC) (such as a skilled nursing facility), to participate in “discharge planning.”
CMS Administrator Seema Verma said: “Today’s rule puts patients in the driver’s seat of their care transitions and improves quality by requiring hospitals to provide patients access to information about PAC provider choices, including performance on important quality measures and resource-use measures – such as measures related to the number of pressure ulcers (bed sores) in a given facility, the proportion of falls that lead to injury, and the number of readmissions back to the hospital.”
Verma added, “The Trump Administration is committed to empowering patients, and CMS is getting it done. Today’s rule is a huge step to providing patients with the ability to make healthcare decisions that are right for them, and gives them transparency into what used to be an opaque and confusing process.”
As of October 21, 2019, according to Medicare.gov, Nursing Home Compare, an official U.S. Government website, the One-Star (Much Below Average) nursing homes in Las Cruces are Invigorate Post Acute of Las Cruces, Casa De Oro Center, and Casa Del Sol Center. The Three-Star (“Average”) homes are Good Samaritan Society — Las Cruces Village, and Welbrook Senior Living, Las Cruces, LLC. Rated five stars, or “Much Above Average,” is Village at Northrise (The) Desert Willow 1.
At the present time, no Medicare- or Medicaid-certified nursing home in Las Cruces is rated Four Stars, or “Above Average.”
Readers can infer what might be expected from a “Much Below Average” nursing home. But people who want the facts can get details ranging from health inspection results to staffing levels by going to Medicare.gov, selecting the Binocular icon, “Find Care,” then “Nursing Homes.” Then they can type in a Zip Code, such as Las Cruces 88011. For example, all six Las Cruces government-certified nursing homes will show up and then readers can compare up to three at a time. They can work down to the detail level, by selecting individual nursing home names from a list.
Comments about this article from nursing homes, MountainView Regional Medical Center, and the New Mexico Department of Health appear at the end of the article.
The new rule change is long overdue. For decades, families of patients being released from a hospital to a nursing home have faced a big problem. Hospitals might tell the family their loved one was being released and tell the family to find a nursing home as soon as possible, sometimes the same day, or the next day. Some hospitals would tell the family that the hospital was not permitted to recommend a nursing home. Others would provide a simple list with nursing home name, address, and phone number, and an indication of whether the nursing home accepted Medicare and Medicaid patients. Patients would not be told about the government rating system.
The Commonwealth Fund reported on August 8, 2017 that most hospital patients who required care from a nursing facility following their discharge received no information about the quality of available facilities, according to interviews with patients and medical staff.
In the Commonwealth Fund study, a research team interviewed 138 staff members at 16 hospitals and 25 nursing facilities across eight U.S. markets. The team also interviewed 98 patients admitted to 14 of the nursing facilities in five of those markets.
When researchers asked the 98 patients what information they had been given by hospital staff members to help them select a skilled nursing facility, only four patients said that they had received any information about quality or instructions about where to find such data. Instead, patients made comments such as this: “I got a two-page list of different facilities that I could go to. It basically was the name, the address, and a phone number.”
In the case of my mother, described in my book, “Mary Regina’s Nursing Home,” www.wbeerman.com, failure of the hospital to provide useful information about nursing homes had tragic consequences. She ended up in a poor-performing sub-par facility (Two Stars) and was dead within a month of admission. Before breaking her hip and being sent to a deficient nursing home for rehab, she had been very viable and was living independently in a senior citizen apartment building. That was in 2011. So the problem with lack of helpful hospital guidance about nursing homes has been around a long time.
Ironically, a One-Star nursing home has the highest occupancy rate in Las Cruces: 94 percent. That’s higher than the 92-percent occupancy rate of the city’s Five-Star “Much Above Average” nursing home.
After implementation of the rule change, there may still be a lot of sub-par nursing home beds in Las Cruces, but patient awareness of their options should be greatly improved.
Numbers of health citations reported in the most recent health inspections were 20 for Invigorate, 15 for Casa De Oro, and 24 for Casa Del Sol, for an average of 20 for the 1-star homes. The numbers of citations for the 3-5 star homes in Las Cruces were 22 for Good Samaritan, 10 for Village at Northrise, and 16 for Welbrook, for an average of 16. The average number of health inspection citations in nursing homes in New Mexico is 11.8, and the average for the U.S. is 8.1.
For the total of the 59 Las Cruces nursing home citations, the New Mexico Department of Health classified all but two as “minimal harm.” One was classified “immediate harm” and one was classified “actual harm.” Both of those involved pressure sores.
Comments from Nursing Homes
The Good Samaritan Society — Las Cruces Village
Michelle Garrey, Administrator, wrote: “The Good Samaritan Society — Las Cruces Village is celebrating 40 years of providing high quality services for residents, giving family members peace of mind that their loved ones are in a safe and secure environment surrounded by a devoted staff. We align with CMS on helping families make the most informed decision when selecting a long term facility, and support public reporting and transparency of nursing center data. As changes to the Five-Star rating system are made in the future, we will continue to work with CMS to ensure clarity in how centers are ranked while including metrics such as customer satisfaction to improve the system. Thank you for the opportunity (to preview the article and comment).”
Casa Del Sol Center, Casa De Oro Center, and Village at Northrise
For Peak Medical Las Cruces, LLC, legal business name for Casa Del Sol Center, Casa De Oro Center, and Village at Northrise, Lori Mayer, Media Relations, wrote: “We support making relevant, transparent information available to patients, residents, and their families to make informed care decisions as provided by the Centers for Medicare & Medicaid (CMS) Five-Star Quality Rating System. This rating system is comprised of several factors – survey/inspection results, staffing levels, and clinical outcome ratings. We recommend that prospective patients review all three factors and not just the overall rating. For example, a significant component of the rating system is based on a center’s annual survey results over the last three years. As such, a survey score may not accurately reflect operations at the center today. In addition, CMS’s rating does not incorporate customer satisfaction scores. Our customer satisfaction ratings, conducted by an external research organization, are posted on our website by center at www.genesishcc.com. Additional reviews can also be found on Google. Finally, we recommend families take a tour of the facility so they can make an informed decision.”
Comments from Hospital
Las Cruces’s two major hospitals, MountainView Regional Medical Center, rated One Star on a Five-Star hospital rating scale by Medicare.gov, and Memorial Medical Center, rated Two Stars, are rated in part on customer satisfaction (called patient care experiences), unlike nursing homes, which are not rated on customer satisfaction by the government. In one of these customer satisfaction rating categories, only 47 percent of patients from MountainView and 50 percent from Memorial said they strongly agreed that they understood their care when they left the hospital. Other details about ratings are under “Find a Hospital” on Medicare.gov. Below is MountainView’s response to the article. Memorial did not provide a response.
MountainView Regional Medical Center
Ben Woods, Director of Business Development and Marketing, for MountainView, wrote: “We thank you for your outreach and for affording MountainView Regional Medical Center the opportunity to respond to your forthcoming article. We appreciate the time and effort you put into your piece and your concern for this issue at hand.
“MountainView Regional Medical Center is doing its due diligence to ensure we are planning discharges effectively, transparent in providing informed patient choice, and validating that our patients have access to the highest quality care our area has to offer.
“To support the continued healing of our patients post-discharge, in early 2018, MountainView Regional Medical Center formed our Post-Acute Collaborative (PAC) with the post-acute providers in our market – hospice, home health, skilled nursing, and inpatient rehab — revamped our patient choice list, educated staff and clinicians on quality data, and established new performance scorecards.
“Our case managers are kept appraised on post-acute performance and our patient choice list includes quality metrics for each facility and disclosure of our ACO; these tools are used by case managers to assist patients and families in making an informed choice.
“Discharge needs are anticipated through a needs assessment within the first two days of admission and transition planning is finalized prior to the day of discharge and ensures we are getting patients to the most appropriate level of care for their needs to reduce waste. We emphasize choice based on quality of care but there are times when a patient’s choice is limited based on their insurance/payer source and bed availability at the SNFs (Skilled Nursing Facilities).
“Each month we request and obtain standardized data metrics from each PAC entity in the ACO on our patients discharged and analyze data from CMS when it is released quarterly to drive change. We hold readmission collaboratives monthly with our PAC partners to review all 30-day readmissions from the month prior. In relation to SNF, per our latest CMS data, we have decreased the SNF average length of stay days from 22.5 to 20.8 and reduced overall SNF readmissions from 22 percent to 17 percent.
“The emphasis we have placed on this effort since January of 2018 has positively impacted patient understanding of their post-discharge care plan.”
Comments from New Mexico Department of Health
Below is a bulleted list of questions I submitted to the DOH, and its replies, which were provided by David Morgan, Media and Social Media Manager.
“Thank you for taking time to reach out to us with your questions. We’ve worked with our Division of Health Improvement to try to provide you some answers. If you have any follow-up, please let us know.”
- Does NM DOH intend to check for compliance with the new rule on discharge planning as it surveys hospitals and/or nursing homes?
“The New Mexico Department of Health’s state survey agency complies with all required facility survey intervals. The Department of Health conducts onsite surveys to verify a facility’s compliance with all existing and/or newly implemented conditions of participation and regulations.”
- Two thirds of the nursing home beds in the City of Las Cruces are rated One-Star and about 278 people are staying in those nursing homes. Does the NM DOH have any corrective action options to fix such situations in which residents of a city seem exceptionally likely to end up in One-Star nursing homes?
“Provided below is the link to the CMS star rating system. A facility’s star rating is based on the factors listed in the link. The Health Facility Licensing and Certification department focuses on a facility’s compliance with licensing and regulations. The Department of Health provides facilities and their leadership with survey data and trends to assist in continual regulatory compliance. Both the New Mexico Health Care Association (an association of nursing home operators) and Comagine Health have a role in the mission to improve the quality of nursing care in New Mexico.”
- Operators of One-Star nursing homes receive the same payments as higher-rated homes, yet the patients most likely receive inferior care, in some cases simply because bad luck landed them there. Can the NM DOH address such unfair situations?
“The Department’s Health Facility License and Regulations team is not involved in the reimbursement process. Residents have a right to choose the nursing home they want to be placed in.”
- All but two of the 59 citations issued to Las Cruces nursing homes during the most recent round of inspections were categorized by the New Mexico Department of Health as “minimal harm with potential….” Is this a typical ratio (2 of 59)?
“Each facility survey is unique to that facility. The term “minimal harm with potential…” pertains only to scope and severity of the deficiency cited. All nursing homes are required to have available three years of survey history on site for consumer review. The statement of deficiencies report outlines each and every regulatory violation found during the survey cycle.”
- Ironically, one of the One-Star nursing homes had the highest occupancy rate in town (94 percent), even a couple of points higher than the Five-Star nursing home (92 percent). Is there an explanation for why this situation would exist, since it would seem to be contrary to expectations?
“The Department of Health does not oversee the CMS Star rating system. Please see links below for how nursing homes are rated.
“Link for Star Rating: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html
“State Operations Manual: Chapter 7- Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107c07.pdf“
Governor Michelle Lujan Grisham
Considering her well-known expressions of concern about nursing homes, and the fact that she once went under cover in a nursing home, comments were sought from the Governor about this article. However, her spokesperson said: “I’ve read the article and I think it’s one the governor will be interested to read — but as she is out of town currently and through next week, and thus out of pocket, I am unable to confirm with her at present whether she’d like to comment or not. I appreciate, though, your reaching out and giving her the opportunity.”
Additional timely news about nursing homes: Nursing Home Monitor