Nearly two-thirds of state skilled-nursing facilities ranked at the highest level

James Gomez
James Gomez

By coincidence, The Sacramento Bee series “Nursing homes unmasked” was published during the annual membership meeting of the California Association of Health Facilities.

While The Bee focused on corporate structures, the association was honoring 20 individuals who each have devoted more than 25 years to careers in long-term care.

People like Myrna Mendoza, a licensed vocational nurse and a cancer survivor who has served elderly residents at the same location for 30 years. And Angie Beeson, who rose through the ranks as a certified nursing assistant, a licensed vocational nurse and finally a registered nurse, and has trained more than 1,500 certified nursing assistants during her 29-year career.

These are the people behind our continuing improvements in delivering quality care. It is their work and dedication that has made California No. 1 in the nation in three categories including preventing depression, weight loss and a decline in activities of daily living – and second in the nation in preventing falls that result in injury.

Our members and their staffs shine when it comes to everyday issues that matter most to residents and family members.

In 2012, members of the California nursing-home profession made it a priority to reduce the unnecessary use of antipsychotic medication. In just two years, skilled nursing homes reduced the use of these drugs by 26 percent. Our providers have done a better job in this effort than 37 other states.

For the last several years, the federal government’s Five-Star Quality Rating System has considered inspection reports, staffing levels and nine separate quality measures such as incidence of pressure sores and changes in a resident’s mobility when ranking nursing homes.

Almost two-thirds of California skilled nursing facilities, 59 percent, are ranked at the highest level, with four or five stars. In October, the federal Centers for Medicare & Medicaid Services announced plans to expand the system even further, with more details about nursing-home performance to help consumers make informed choices. That wasn’t good enough.

The Bee chose to also judge nursing homes by an even higher standard, using a tougher, independent ranking system from the California HealthCare Foundation, which believes superior nursing homes should have double the number of staff now required by the state.

No matter which industry is measured, there will always be those that fall above and below the median. However, The Bee series went to great lengths to identify companies with “lower than average” staffing when those same companies actually met or exceeded the state’s staffing requirements.

For a different perspective, compare California to the rest of the nation. The federal government looks at payroll information to determine staffing levels using data from the Centers for Medicare & Medicaid Services’ Certification and Survey Provider Enhanced Reports database. In 2013, California staffing levels were among the highest in the nation, ranked No. 11.

Most of our residents – about two-thirds – depend on government assistance, or Medi-Cal, to cover the cost of their care. Using a complicated and inefficient payment system, California pays nursing homes just 92 cents on the dollar for 24-hour care. Nevertheless, critics continue to demand staffing increases that are financially unsustainable.

The one-on-one care that our members deliver each day is underscored by a daily commitment to quality. Hundreds of skilled-nursing facilities in California have volunteered to be part of a national effort initiated by our national affiliate, the American Health Care Association.

The Quality Initiative sets specific, measurable targets to further improve quality of care, and members are encouraged to reach defined goals in four core areas by 2015. These include safely reducing the off-label use of antipsychotics by 25 percent, (already achieved), safely reducing hospital re-admissions by 15 percent within a 30-day period, reducing staff turnover by 15 percent and increasing the percentage of customers who would recommend the facility to others to 90 percent.

The structure of a corporation might be important to plaintiffs’ attorneys, but it probably matters less to the daughter of a resident suffering from the ravages of Alzheimer’s or the son of a nursing-home patient with heart failure, or to most of the 300,000 people who use skilled nursing each year. Even though 85 percent of people express satisfaction with our services, we continue to strive to be better because that’s what our loved ones deserve.

James Gomez is CEO and president of the California Association of Health Facilities.