Post nursing home scores, board urges

Los Angeles County supervisors have asked state officials to compel California nursing homes to prominently post their new federal star ratings, much in the way restaurants display letter grades.

But the proposal faces opposition from patient advocates and nursing home officials who fault the five-star ratings system that went into effect last month, saying it overlooks significant violations and sometimes penalizes well-run nursing homes.

California is home to 1,254 federally rated nursing homes, more than any other state. Of those, 272 received the lowest rating, one star, and 148 received five stars.

The county’s five supervisors unanimously voted last week to petition Gov. Arnold Schwarzenegger and state health department officials to back the plan.


Under their proposal, which also calls for information about the ratings system to be included in any admissions agreements for new patients, any nursing home in the state that receives Medicare and Medi-Cal would be required to display its current star rating on site.

Spokesmen for the governor and state health department said they are considering the supervisors’ proposal, which would have to be sanctioned by Sacramento because nursing homes are licensed and regulated by the state.

Supervisors also voted to link the county website to the federal rating site, Nursing Home Compare.

If California requires the ratings be posted at facilities, it might be the first in the nation, according to a spokeswoman for the American Health Care Assn. in Washington, D.C., who said her group was unaware of any other states that had done so.


The change would affect about 400 nursing homes in Los Angeles County serving about 30,000 people.

“There’s a great need that the public have more information about the type of facility they place a loved one in,” said Supervisor Michael Antonovich, who proposed posting the ratings.

The Centers for Medicare & Medicaid Services began issuing the star ratings Dec. 18 after patients and advocacy groups complained that nursing home information on the federal agency’s website was difficult to understand and compare.

Federal inspectors rate nursing homes using three years’ worth of data drawn from state inspections and reports provided by the nursing homes.


Homes are scored on staffing and 10 quality measures, including how well a home responds to residents’ declining mobility, high-risk bedsores and pain. Nursing homes receive star ratings in three areas -- health inspections, staffing and quality of care -- plus an overall rating.

“We hope by making the system more transparent we can convince the homes to improve their quality,” said Jack Cheevers, spokesman for the Medicare & Medicaid Services regional office in San Francisco.

Nursing home officials, however, say the ratings rely too heavily on outdated information and can leave false impressions.

Companies such as Los Angeles-based Country Villa Health Services, which took over some troubled nursing homes after Pacific Care filed for bankruptcy in 2007, are penalized for inspections that predate their ownership, said Betsy Hite, spokeswoman for the California Assn. of Health Facilities.


“A building can improve very significantly in a short period of time, and it can also decline,” Hite said. “We have to be careful about how reliable this data is.”

Hite said she urged federal officials to include more recent patient and staff satisfaction surveys in their ratings, but was told federal inspectors did not have time to adjust the ratings before they debuted on the website a month ago.

Patient advocates have also raised objections to the ratings, which they say are based too much on reports from nursing home staffers who have an incentive to make their homes look good.

Nursing home officials often know when federal inspectors are coming and add staff to improve their image, said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.


McGinnis said the rating system should be adjusted to take into account that some nursing homes care for critically ill patients.

With no adjustment for how ill patients are, she said, well-respected facilities such as the two-star Jewish Home of San Francisco have been graded too low.

McGinnis also criticized the decision not to factor in state health department citations. Federal officials chose not to include state citations because citation criteria vary between states, Cheevers said.

That means that when state inspectors find violations, the facility’s federal rating does not change.


The day after getting a two-star rating, Casa Bonita nursing home in San Dimas paid a $121,000 fine and received three citations, including the state’s most severe, related to the death of an elderly patient whose ventilator accidentally disconnected.

State health investigators found that Casa Bonita nurses turned off an alarm that would have warned them when the ventilator used by Rita Twomey, 88, of Duarte disconnected, according to a state report.

Twomey’s daughter, Denise, found her in bed Oct. 27, 2007, with her lips and fingers blue. Denise Twomey alerted nurses and tried to keep her 91-year-old father, whom she had brought for a visit, from going into the room.

“They didn’t even get to say goodbye,” she said of her parents. “That’s the heartache.”


Her mother went to the facility to recover from pneumonia and had been a patient for two months at the time of her death, she said.

The state report noted that Casa Bonita’s failure to follow policy on the use of ventilators and alarms “presented either an imminent danger that death or serious harm would result or substantial probability that death or serious physical harm would result.”

An attorney for Casa Bonita, Elizabeth Tyler of Los Angeles-based Tyler & Wilson, said the nursing home is still investigating the state’s findings and plans to challenge them in court.

Casa Bonita’s federal rating remains at two stars, indicating that it is “below average.” A one-star rating indicates that a facility is “much below average.”


Denise Twomey is suing Casa Bonita in connection with her mother’s death. She also said she wants to see more comprehensive federal inspections and ratings that take into account state citations.

Otherwise, she said, she is worried that “people are going to be fooled.”