Worthless Arizona Nursing Home “Quality Ratings”: Part 1

Arizona Administrative Code R9-10-919 requires the Arizona Department of Health Services [ADHS] to give Arizona nursing homes a “quality rating” based on the results of the nursing home’s license renewal inspection. While such “quality ratings” might seem to be a reliable, objective measure of the quality of care provided in a nursing home, and a useful guide to how well a loved one will be treated, these “quality ratings” are worthless at best; at worst, they can be dangerously misleading.

Currently, the “quality rating” is a letter grade (A, B, C, or D, with D being the lowest rating possible) based on a 100-point scale, with 90-100 points equal to an A, 80-89 points for a B, 70-79 points for a C, and 69 points or less for a D. With one exception (discussed later), the score is based solely on deficiencies discovered during the facility’s license renewal survey, not the cumulative total of deficiencies cited on any complaint investigation surveys conducted since the last relicensure inspection.

As a result, a facility could have serious deficiencies and still receive a high score–-it all depends on what the ADHS surveyors do or do not discover at the time.

Nor does the quality rating evaluate a facility’s compliance with all federal and state regulations; instead, the rating is based on only about 10% of the state regulations–and not even the most important 10%.

For example, in discussing a proposal for the Centers for Medicare and Medicaid Services [CMS] to implement a “Five-Star Ranking System” for nursing homes, the National Citizens’ Coalition for Nursing Home Reform [NCCNHR] notes that five quality measures are strongly indicative of quality of care:

• The percentage of high-risk residents with pressure ulcers;
• The percentage of residents with long-term catheters;
• The percentage of residents with restraints;
• The percentage of residents with urinary tract infections [UTIs]; and
• The percentage of residents with a significant weight loss.

The ADHS “quality rating” system ignores four of them (pressure ulcers, catheters, UTIs, and weight loss).

What this means is that a nursing home can receive a high “quality rating” even though significant and potentially dangerous problems exist at the facility. For example, I recently reviewed the file of a nursing home that received an “A” rating, even though it was cited for violating nineteen federal and state regulations, based on such findings as:

• A medication error rate greater than 5% and failing to ensure that staff administered medications according to professional standards;
• Failing to ensure residents received care according to physician orders;
• Failing to ensure that residents had accurate and complete assessments and that residents’ clinical records were accurate;
• Failing to provide care to prevent potential accidents;
• Failing to provide housekeeping and maintenance services necessary to maintain a sanitary and orderly environment; and
• Failing to store, prepare, and serve food under sanitary conditions.

How could a facility violate nineteen regulations and still receive an “A”? Easily, because only two of those nineteen federal and state regulations are scored by the ADHS “quality rating” system. The most serious violations–-the medication errors, the incomplete and inaccurate clinical records, and the failure to follow physician orders–-did not affect the facility’s score at all.

I’ll post more on this topic next week–-please check back and let me know what you think. You can also learn more by going to our website: http://solomonrelihan.com/