UPDATE: Majority of KC-area nursing homes score below average

Sunday, January 4, 2009 | 5:51 p.m. CST; updated 6:31 p.m. CST, Sunday, January 4, 2009

KANSAS CITY — A majority of Kansas City-area nursing homes came in below average in a new federal database that rates facilities on health inspections, staffing levels and quality of care.

None of the 82 facilities that are within 25 miles of the city and are covered by the Medicare rating system achieved the maximum five-star rating and 72 percent achieved only one or two stars.

Within 50 miles, only three facilities meet the five-star standard, the closest being a small 17-bed facility in Olathe that specializes in short-term rehabilitation.

Medicare began releasing nursing home ratings last month at but has already received criticism from the nursing home industry, which claims the ratings are flawed.

The ratings are based on three years of health inspection reports, ratios of employees to residents and each facility's own reports on prevention of bed sores, medical treatment and other indicators of quality care. They will be updated quarterly.

Medicare officials note that facilities receiving one star are still meeting federal requirements and could be providing good care. Additional stars indicate the facility is going beyond the minimum requirements.

They said family members should still visit potential nursing homes and talk with staff there before choosing a facility, not relying entirely on the ratings system.

"This system is not intended to be the only tool families use in selecting the right nursing facility for a loved one," said Kerry Weems, acting administrator for the federal Centers for Medicare & Medicaid Services, or CMS. "Nothing can substitute for visiting a nursing home."

Twenty-two percent of U.S. nursing homes scored one star and 12 percent scored five stars. But 49 percent of homes within 25 miles of Kansas City — or 40 out of 82 rated homes — received the lowest rank.

Federal and state inspectors said the dearth of high-scoring homes in the Kansas City region could be because of stiff competition for health care workers and the tough time urban facilities have retaining employees.

"There's just such shortages of nurses. In rural areas, there no place else to go to work, there aren't other options," said Jennifer King of the CMS' Kansas City regional office.

"In urban areas, there's turnover and no enough staff, and that leads to not enough continuity of care," King said. "Ultimately, it even affects health inspections."

Most of the five-star nursing homes in Kansas and Missouri are in small towns, such as Lindsborg, Kan., and Malden, Mo.

In addition to the staffing issues, care may be more personal in smaller towns, officials said.

"If you live in a small town and work in a nursing home, you may be taking care of your own relatives or the relatives of your friends," said Tracy Niekamp, program manager for nursing home licensure and certification of the Missouri Department of Health and Senior Services.

Members of the nursing home industry are far from thrilled with the ratings system, complaining they had little input into how the ratings system was developed.

Medicare "wasn't transparent and deliberative about this. They didn't invite anyone to the table," said Jonathan Dolan of the Missouri Health Care Association, a trade organization representing 325 of the state's 500 nursing homes. "It absolutely guts those who are providing care."

Dolan said the ratings should factor in the severity of illnesses affecting a nursing home's residents and include ratings given by the residents themselves and their families.

He also pointed out that nursing homes with the most Medicaid clients tended to have the lowest ratings. In states where the health care program for the poor doesn't fully cover the cost of nursing home residents, like Missouri, facilities with a lot of poor residents will be at a disadvantage.

CMS spokeswoman Mary Kahn acknowledged quality of care could suffer in those circumstances. But she said two-thirds of the information used for the ratings comes from the nursing homes themselves.

"They can't say they don't know areas where they need help," Kahn said. "We have a high level of confidence this (rating system) is based on solid information."

The Hoeger House nursing home in Olathe received a five-star rating and was honored to get it, said nursing director Dena Pflughoft. But she said the facility, which focuses on short-term stays involving patients recovering from surgery or acute illnesses, is far different from nursing homes providing long-term care for critically ill people.

She also had doubts about the ratings system.

"I see facilities that should probably get a higher rating and others that I question why they did so well," she said.

The other five-star facilities within 50 miles of Kansas City include Meadowbrook Rehabilitation Hospital in Gardner and Hillside Village of De Soto.


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