Nursing home details listed online
Web site has inspection results; advocates urge in-person visit

By Naomi Snyder Caller-Times
February 23, 2003
One of Betty Dodds' toughest decisions ever was putting Ralph, her husband of 57 years, in a nursing home.

* www.medicare.gov

Parkinson's disease had ravaged him. He couldn't walk anymore and was down to 117 pounds. So she went on the Internet and found federal information for each nursing home in Corpus Christi, trying to make a good decision about where Ralph should go.

"These people are very important,'' she said while motioning to the nursing staff at Holmgreen Health Center in Corpus Christi.

"I can leave them with someone I love very much," she said, choking on her emotions.

The 77-year-old Ralph has gained 30 pounds since his admission in September. He can handle some walking, and maintains a sense of humor about his condition, joking that he needed to pose for a photograph with a stuffed monkey on his back.

Nursing homes often strike the elderly with waves of fear and much has been made public about nursing home abuse.

But now, as a way to help residents and families get information about individual nursing homes, the federal government has published details through www.medicare.gov on every nursing home in the country certified to take Medicare and/or Medicaid.

Most of Corpus Christi's nursing homes have in-depth, publicly available reports through the Centers for Medicare & Medicaid Services, reports about inspections and quality, including how many residents have bedsores and how many are in pain.

Nursing home advocates and industry
representatives say the data are not a surefire way to know the best and worst nursing homes in your city. The only way to make a final decision on a nursing home is to include a visit and interviews with staff, several industry representatives said. But reviewing the available information is a start.

Of the 13 homes listed in Nueces County, most were below state and federal averages when it comes to percentages of patients in pain, according to the reports. And many had higher-than-average percentages for restraints.

Restraints can range from vests to chairs with lap trays, and are generally considered bad if widely used. Bed rails are not included in the statistics.

Holmgreen, on Carancahua across the street from
Trinity Towers, had 25 percent of its residents in restraints in its last report. Other nursing homes ranged from a low of zero percent to 42 percent in restraints, according to reports.

The Holmgreen administrator, Marta Wellesley, explained that restraints often are used to keep people from hurting themselves, especially from falls. But the center is trying to reduce its use of restraints, partly by educating relatives, who sometimes request them in an attempt to protect loved ones.

"Our family members are extremely demanding,'' she said. "They used to call the shots. But we're meeting now with family to explain the dangers of restraints, and we're getting those numbers down."

Holmgreen, which is owned by American Retirement Corp., had zero deficiencies in an inspection dated June of last year, the least of any nursing home in the city. The home takes private-pay and Medicare patients, but not Medicaid.

Other measures of nursing home quality in Nueces County couldn't be put in a single category.

In a survey of deficiencies, or problems inspectors saw in homes, IHS of Corpus Christi had 25 deficiencies in an inspection dated March of last year, the most of any nursing home in the city, according to a report.

The report said the home in the 1300 block of Third Street had failed to "protect residents from mistreatment, neglect, and/or theft of personal property." The report also said the deficiency had been corrected in April. The home's administrator said many of the deficiencies, including that one, had to do with following written procedure, and all had been corrected.

Deficiencies reversed

Two of the deficiencies, related to infection control and screening of employees, were later reversed after the nursing home appealed, said a spokeswoman for the Texas Department of Human Services.

It's important to note that updates after deficiencies are overturned or their severity is reduced on appeal don't make it to the Web site.

That upsets IHS administrator Nancy Wilsford, who has served as administrator there for 15 years.

"If they don't go in and update it, it's going to stay there until the next year and that's not fair to any home in Texas,'' she said. "We all love these residents. That's why we're here."

Holmgreen's administrator said the annual inspections are extremely difficult to pass and conditions can change on a daily basis.

Many rulings overturned

"There isn't one place that is perfect," said Holmgreen administrator Wellesley.

Others doubted the data's ability to say who is best and worst.

David Thomason of the non-profit nursing home group the Texas Association of Homes and Services for the Aging, said one home in the state even was cited for giving fruit to residents in Dixie cups.
It was considered degrading, he said.

He said that last year, 42 percent of deficiencies later were overturned after the nursing home complained.

However, Thomason said any information for consumers is a good thing.

"There needs to be more accurate and complete information provided to consumers and I think this is a step in that direction," he said.

Kevin Warren is the nursing home quality director for the Texas Medical Foundation, which contracts with the federal government to try to improve nursing homes in Texas.

He said nursing homes can use the information to try to get better, with the added incentive of information about the quality of care being made accessible to the public.

The group announced last week that 200 homes statewide enrolled in a voluntary program to improve based on data collected in that survey.

Another benefit to the data is consumers using the information to try to find good nursing homes.

"I would say this is one of the most important decisions anyone would make in their lives," Warren said.

Ask staff questions

He advised consumers to ask staff about the
information in the reports. For instance, if the home's residents have a lot of bedsores, ask why.

There may be a perfectly good reason. For instance, the home may specialize in wound care.
If the answer doesn't sound right, be suspicious, he said.

Other factors are important, too.

"How much do you see the staff? Are they making eye contact?'' he said. "Do they appear to be involved with the residents?"

A nursing home that smells like urine can be a bad sign.

"If you walk down the hallway and see a lot of restraints, then you don't want to go there," said Candice Carter, Texas AARP legislative affairs representative. "If you go and it smells bad, that means something."

Also, trays with food on them left around could indicate staff doesn't have time to feed residents properly, she said.

"It's amazing that people actually starve to death in nursing homes. You have to ask, why is that?" she said. "There's nothing better than looking."

Contact Reporter Naomi Snyder at 886-4316 or snydern@caller.com

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