Explaining Medicare's Quality Care Indicators

March 22, 2011

With so many options and a potentially less than concrete understanding of what's what, deciding where to get necessary skilled nursing care isn't always the easiest decision. To help provide a starting point for your search, Medicare developed a Quality Rating System that is based on three sources of information: Health Inspections, Staffing and Quality Measures.

Below are short, "plain English" explanations of each quality indicator. Please comment or e-mail us if you have any questions. Remember: If possible, ALWAYS visit a facility before deciding where to go.

Health Inspections: Every year, facilities have a standard health inspection if there are complaints at another point in the year then another inspection may be conducted as well. Medicare evaluates the results of all health inspections the facility has underwent in the last three years, and determines a numeric rating based on those results.

Staffing: In skilled nursing, there are guidelines for how many hours per day each patient is to be cared for by an RN, Certified Nurse Aide, etc. Depending on how the facility compares to those guidelines determines the facility's staffing rating.

Quality Measures: This is the most difficult part of the quality equation to understand, because so many factors are at play. Based on 10 different physical and clinical measures, the "quality of care" is measured. For example, if a facility reports a disproportionally large number of cases of bed sores, this would, in theory, bring down the quality rating. This is also the most subjective of the quality indicators, as the differences in facility-type aren't very well accounted for.

For instance, a facility with emphasis on short-term rehab and quicker resident turnover will likely reflect higher reported levels of pain, since many residents were admitted shortly after an elective surgery. A long-term facility, on the other hand, may report higher levels of incontinence, since there is a much higher percentage of residents at an advanced age. Both of these situations would reflect lower overall quality statistics according to Medicare's standards.

Concordia Lutheran Ministries Vice President for Skilled Nursing and Rehab Charlene Kline said there are a number of indicators Concordia uses to gauge its quality standards internally, including consistently exemplary patient/resident satisfaction surveys, occupancy statistics that often show a waiting list and a large volume of patient-to-patient referrals.

Two other indicators of the excellent quality at Concordia are a low staff turnover rate and a new concept that is becoming more and more prevalent in the skilled nursing sector of Concordia: dozens of patients every month reserving rooms for their upcoming post-surgical rehab needs.

For an in-depth look at Medicare's quality indicators, visit the rating system portion of Medicare's website here or the Nursing Home Compare portion of the Medicare website here.

For more on the excellent caregiving options at Concordia's three skilled nursing facilities in western Pennsylvania, visit the Skilled Nursing page of our website.

To contact an admissions counselor at one of our locations, visit the Contact Us page on the Concordia website, call toll free at 1.888.352.1571 or e-mail here.

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