New nursing home ratings released last week by the federal government are shining a new light on major problems with funding and quality of care in Louisiana.
NEW ORLEANS – New nursing home ratings released last week by the federal government are shining a new light on major problems with funding and quality of care in Louisiana.
There are 32 Medicaid-funded nursing homes within 25 miles of downtown New Orleans. Last year, seven of the homes got the highest, 5-star overall rating and only three got the worst, 1 star.
But the federal Centers for Medicare and Medicaid Services promised tougher scoring this year, and now the number of top scorers in the New Orleans area is down to just three: the John J. Hainkel Home in Uptown New Orleans, the Ochsner Foundation Skilled Nursing Facility in Jefferson and Riverbend Nursing Home in Belle Chasse.
Meanwhile, the number of 1-star nursing homes has doubled from three to six. Maison De'Ville in Harvey and Jefferson Health Care each lost a star from last year, and St. Anthony's in Metairie dropped from 3 stars to 1. They joined Carrington Place of New Orleans and Waldon Health Care and Chateau Living Center, both in Kenner, which had already ranked at the bottom.
Louisiana Nursing Home Association Executive Director Joe Donchess said the new ratings are confusing and make it look like things have gotten worse when he claims they're actually improving.
"Let's say you have a 15-year-old son and he leaves for school that morning as an A student," Donchess said. "He comes back that afternoon as a C student, and the parents ask him what happened, and he said, 'There's a new grading curve and therefore I'm not an A student anymore.' The parents say, 'You're still as smart as you were when you left this morning.' And that's how we feel about this system."
But changes in the grading curve don't account for the fact that Louisiana ranks dead last in the country in high incidence of bed sores, the use of physical restraints and nurse staffing levels.
Bruce Blaney, a former state Health Department undersecretary and an advocate for home health care services rather than nursing homes, said the new grading system is long overdue for catching serious problems that have been plaguing local nursing homes for years.
"These (patients) are walking around with tardive dyskinesia from having four or five psychoactive med(ication)s at a time," Blaney said. "I mean, that's what the star-rating finally started to take account of. Let's look at psychoactive drugs. Because that's where the money is. (Nursing homes) substitute drugs for staff."
Sen. David Heitmeier, D-Algiers, an optometrist who heads the Senate's Health and Welfare Committee, says the staffing problems will remain as long as the state reimburses at lower levels than Mississippi and Arkansas.Donchess acknowledges that nurse staffing levels are low in Louisiana, but he attributes that to the state's low Medicaid reimbursement rates, making it harder for nursing homes to pay registered nurses rather than nursing assistants and non-certified staff.
Heitmeier said he is concerned about the use of anti-psychotic drugs, which inspectors cited as a problem 231 times at Louisiana nursing homes between 2011 and 2013, according to a Legislative Auditor's report last year.
But Blaney said Heitmeier and his legislative colleagues could have done more to respond to the audit, which also highlighted wasteful use of Medicaid reimbursement dollars.
"The reason they're not doing anything about it is they're getting a lot of money from the nursing home association," Blaney said.
According to a review by the independent newsroom ProPublica, Louisiana nursing homes average a serious, health-threatening deficiency every year. That's one of the worst rates in the country and about three times the national average.
Part of the problem stems from Louisiana's high rate of "acuity," meaning nursing home patients tend to be sicker in Louisiana than in other states. That's because Louisiana has the second highest percentage of chronically ill elderly, Donchess said.
He also said regional inspectors are tougher in the Southern regions, Region VI, which includes Louisiana, and Region IV based in Atlanta, helping to explain the high number of deficiencies.
And yet, the state issues only an average number of fines against the nursing homes, compared with the rest of the country. Donchess questioned those findings by ProPublica, saying the fines are plenty harsh in Louisiana.
Meanwhile, the legislative auditor's report also identified waste at the state level.
The Jindal administration drained almost every penny out of the $830 million Medicaid Trust Fund for the Elderly over the last seven years.
Louisiana is also one of the only states that reimburses nursing homes with Medicaid dollars for their non-Medicaid patients as well as for their Medicaid ones, leading to what the audit called excess capacity costs of more than $15 million a year.
"We are going to be short dollars, and if we are wasting health care dollars, it is something that we should look at," Heitmeier said.
The state also reimburses nursing homes as if 85 percent of their beds are filled, even though a quarter of the beds statewide are empty, meaning the state is paying for empty beds at about 70 percent of nursing homes, according to the auditor.
Donchess said that's not really true because nursing homes must eventually pay back excess money in the form of penalties for every unoccupied bed under the 85-percent threshold.
Donchess also said ihis industry is being proactive to try to get rid of excess beds by creating buy-back and room-conversion programs.
But Blaney said Gov. Bobby Jindal's administration and the Legislature are ignoring the demand for expanded in-home care. When Jindal was head of the Louisiana Department of Health and Hospitals and Blaney was working under him, the state expanded waivers for home-health reimbursement under Medicaid. But the state has slashed support for that alternative in the last five years, in favor of giving extra help to nursing homes.
He said until the state leadership changes course, the nursing homes have little incentive to change.
"You put a lot of people under one roof and very few staff and you can make tons of money," he said. "That's all they care about. They don't care about the quality of care. They don't care about putting resources into care. They're making out like a bandit."