Better-rated nursing homes often found in state's affluent areas

Survey notes key exceptions

By Steve LeBlanc
Associated Press / January 2, 2009
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More affluent areas of Massachusetts tend to have higher quality nursing homes, according to an Associated Press review of federal data.

The AP review of Centers for Medicare and Medicaid Services data found the quality of nursing homes varies widely by region, but better care is often found in areas with higher income levels.

The agency studied factors such as staffing levels and annual health inspections before ranking nearly 16,000 nursing homes in the country with one to five stars. Five-star homes offered the best services and care. Three-star homes were about average. One-star homes were rated well below average.

Overall, Massachusetts ranked ahead of the nation.

Seventeen percent of the 433 Massachusetts nursing homes reviewed were given five stars, ahead of the national average of 12 percent. Just 14 percent were rated with a single star, far fewer than the national average of 22 percent.

But a deeper look at the Massachusetts statistics revealed that nursing homes in more affluent counties often ranked higher than nursing homes in poorer counties.

In Middlesex County, one of the wealthiest counties in Massachusetts based on median household income, nearly 60 percent of nursing homes were rated with either four or five stars - the second highest of any county in the state, based on the AP review.

By contrast, in Hampden County, the poorest county in the state, nearly six out of ten nursing homes were ranked with just one or two stars. The county also ranked last in the percentage of five-star nursing homes.

Other counties saw a similar pattern.

Plymouth County, the third wealthiest in the state, also ranked third in the list of counties with the highest percentage of four and five-star nursing homes.

Berkshire County, the second poorest county by income, had the highest percentage of nursing homes with the worst rating of just one star.

And in Worcester County, with a median income slightly below the statewide average, one out of four nursing homes were given single star ratings, while about one in ten were given the top rating.

There were a few exceptions.

In Norfolk County, the state's wealthiest based on income, just a third of the facilities were rated with four or five stars, leaving it in the middle of the pack, although it did have the lowest percentage of one-star nursing homes.

And Suffolk County, the third poorest county by income, had the highest percentage of five-star nursing homes and one of the lowest percentage of one-star homes. Suffolk County includes Boston, with its high concentration of teaching hospitals and healthcare facilities.

The AP review looked only at counties with more than 10 nursing homes, exempting Dukes, Franklin, Hampshire, and Nantucket counties.

John Jacob, a spokesman for the state Department of Public Health, said state health officials were pleased with the state's national ranking.

The findings of three years of state inspections were among the factors considered in the ratings. The inspections look at a series of quality measures, such as the number of patients with bed sores after their first 90 days in a facility. Other factors include staffing levels and the number of injuries from falls.

Elissa Sherman, president of the Massachusetts Aging Services Association, whose members include nursing home owners, said the rating system is flawed because it doesn't consider factors such as family satisfaction.

"There are some facilities with excellent reputations who did well on staffing but had a poor state inspection and were rated very poorly," she said.

But Karen Clay, director of nursing at the Berkshire Rehabilitation and Skilled Care Center in Sandisfield, which received a five-star rating, said the system can give a good snapshot of a facility.

"Anyone can have a rough survey one year, but if you have three years of tough surveys there may be something to it," she said.

Alan Rosenfeld, president of the Julian J. Leavitt Jewish Nursing Home in Longmeadow, which received three stars, said some parts of the state had fewer four- and five-star homes because quality inspectors there tended to be tougher, not because of relative affluence.

"There is great variability and that has more to do with the [inspectors] than the quality of the institution," he said.

He also said some factors - like the frequency of falls - worked against facilities with higher numbers of individuals with Alzheimer's disease, who can be more prone to falls. Of 200 beds in his nursing home, 80 are for Alzheimer's patients.

The highest ranking in the nation went to Delaware, where 30 percent of nursing homes got five-star ranking. States with the highest percentage of one-star nursing homes were: Louisiana, (40 percent); Georgia (32 percent); Virginia (32 percent); and Tennessee, (31 percent).

Industry representatives cautioned against comparing states, saying some states have tougher inspections than others.

Federal officials and nursing home owners agree nothing should replace visiting a home before making a final decision on its quality.

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