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Indiana's Nursing Homes Rank Among the 10 Worst in the United States

January 6, 2009

Indiana nursing homes rated among worst
By Heather Gillers, Indianapolis Star

A staffing shortage is driving down the quality of care at Indiana nursing homes, putting the state among the 10 worst in the nation, according to an analysis of recent data released by the Centers for Medicare & Medicaid Services.

Almost 28 percent of the state's nursing homes received the lowest rating -- one star -- in the federal rankings, which measure health and quality-of-life indicators. Only six states had a higher percentage of substandard nursing homes.

Overall, the study found that about half of Indiana's roughly 500 nursing homes offered a ""below-average"" standard of care.
NURSING HOMES: Click"">"">Click here for a searchable database of nursing home ratings.
Robyn Grant of United Senior Action, a statewide nonprofit advocacy group, called the findings ""disgraceful and a cause for alarm.''

""Given the weight that the new system assigns to staffing,"" she said, ""our low ranking indicates what families and residents tell us every day: that there are not enough nursing staff to provide even the most basic care.""

Indeed, 39 percent of Indiana nursing homes received the lowest score in the area of staffing, compared with 22 percent of facilities nationwide. Nearly 60 percent had below-average staffing levels, compared to 42 percent nationwide.

State Department of Health spokesman Ken Severson called the rankings ""one of many tools"" for choosing a facility. He declined to comment on how Indiana compares with other states. Still, even Indiana nursing homes know the state has catching up to do.

Stephen Smith, president of the Indiana Health Care Association, which represents nearly 300 nursing homes, said that when its members were surveyed, ""turnover was the number one problem.""

Smith said pay is one problem, and his group is working with lawmakers to push for pay raises for nursing home staff.

IHCA's parent organization, the American Health Care Association, determined that Indiana has a 93 percent one-year turnover rate for certified nursing assistants, compared with 66 percent nationwide. That means that every year Indiana nursing homes must replace almost their entire certified nursing assistant staff.

It also means that at any given time, there are ample vacancies that create staffing shortages. For example, the AHCA looked at June 30 and found that 26 percent of nursing jobs in Indiana nursing homes were open, compared with 16 percent nationwide. The organization found that 14 percent of certified nursing assistant positions were open, compared with 10 percent nationwide.

Linda Daniels, who has worked as a certified nursing assistant at five Central Indiana nursing homes, said she repeatedly saw staff spread thin.

""You have to get (residents) dressed, get them down to the dinner table,"" Daniels said. ""You have to watch all the call lights. . . . If somebody passes away, you have to clean them up. . . . People think it's easy money, but it's not. CNAs have the dirty work.""

In addition to staffing levels, the Centers for Medicare & Medicaid Services also based its rankings on how well Indiana homes complied with federal care cleanliness, safety and quality-of-life standards during inspections conducted every 18 months by government surveyors and on the regular reports the homes themselves make about patient health.

Indiana performed more or less in line with other states in both categories with one notable exception. Homes here reported that 22 percent of their residents needed increasing help with daily tasks after more than 90 days in the facility. Nationwide, only 15 percent of nursing home residents deteriorate at that level.

Concern for a sister

Substandard nursing home care can result in such things as a resident missing dinner or developing bedsores.

Sometimes, it's much worse.

Joyce Joiner, 54, Merrillville, was appalled when she visited her sister Pam Matthews at the North Lake Nursing and Rehabilitation Center in Merrillville about a year ago.

Matthews, 57, is paralyzed on her left side after a stroke three years ago. Joiner said she had shrugged off signs of ""a little neglect"" on previous visits to the nursing home, such as the time she found Matthews' head wedged against a bed rail.

Then one night in October 2007, according to a report by Merrillville police, Joiner walked into her sister's room to find a call light lodged in her sister's rectum.

""She is paralyzed, and there ain't no way in the world she could have done that,"" Joiner said. ""Evidently somebody got upset with her because she would poop.""

Matthews moved to a new nursing home, and Joiner is considering legal action against North Lake Nursing and Rehabilitation Center.

A woman who identified herself as an attorney for North Lake had no immediate comment on the allegations. The facility received the lowest possible overall score in the Centers for Medicare & Medicaid Services rankings.

Experts from the advocacy group to the trade organization agreed that the rankings are not a definitive tool for determining which nursing home is best. They said only frequent visits can ensure a resident is getting good care. But the data provide more information and, in Indiana, a warning.

""It just suggests how important it is to choose wisely,"" said spokesman Martin DeAgostino of AARP Indiana. ""Choose carefully and just be very diligent at monitoring the care your loved one gets once they are in a nursing facility."