La. nursing homes rank poorly, report states

Louisiana nursing homes rank among the worst in the nation in key quality measures, with high rates of bed sores and use of restraints among the 25,000 elderly and disabled people who live in them, the state legislative auditor reported Monday.

In addition, the informational report said Louisiana has the lowest overall nursing staff out of all 50 states. The auditor’s report looked at occupancy rates, costs to the state and quality of care delivered at the state’s 259 Medicaid nursing facilities.

“This report reveals what we’ve known for some time. Louisiana spends billions of dollars on low-quality nursing home care, rather than on affordable supports and services people most need to successfully live at home,” said Nancy McPherson, Louisiana state director for AARP, a seniors advocacy group. Eighty-nine percent of Louisiana residents, according to AARP surveys, want to live in their own homes or communities as they age.

Joe Donchess, executive director of the Louisiana Nursing Home Association, said the reason for the negative findings is that the audit relied on reviews by the federal government, whose inspectors are more stringent on Louisiana than on other states. Louisiana’s Medicaid nursing homes are assessed by the federal Centers for Medicare and Medicaid Services, or CMS.

“They are real tight sticklers,” said Donchess, whose trade association represents nursing homes, some of which were included in the audit.

In Louisiana, for instance, a reviewer may cite a home for a physical restraint, but in another area, it’s deemed a wheelchair assistance device, he said.

Some of the other negatives cited — nursing staff levels and empty nursing home beds, for instance — have come up before and efforts are being made to address those issues, Donchess said.

But a champion for the rights of the elderly and disabled said the audit’s findings were chilling.

“We have seen reports on this, but this is the worse I’ve ever seen,” said Bruce Blaney, with the Supported Living Network, which represents providers of home- and community-based services. “It’s unconscionable. … It should lead to an investigation of nursing homes and a reform initiative.”

The issuance of the report comes as the state prepares to move into the arena of managed care for the elderly and developmentally disabled. State officials have said they are looking to provide more community-based services in a state where institutions, like nursing homes, have been relied on heavily.

“The purpose of this report is to provide information,” wrote Legislative Auditor Daryl Purpera, “in order to evaluate in the future the impact of managed care in these areas.”

The report will be followed by separate reports on intermediate-care facilities for the developmentally disabled and community-based services, such as those delivered through the New Opportunities Waiver and Long-term Care Personal Care Services programs.

During fiscal year 2013, the state’s nursing homes received approximately $840 million in Medicaid payments — 24 percent of the private provider payments made through the government health insurance program for the poor, the report said.

Medicaid, the program funded by state and federal taxpayers, spends more on services at nursing homes than at hospitals.

“We have been working with providers to improve our nursing homes and to transfer individuals out of institutions and into home and community settings,” state Department of Health and Hospitals Secretary Kathy Kliebert said in a prepared statement.

The auditor’s report includes a chart listing each of Louisiana’s Medicaid nursing homes, their CMS rating, their per-patient/per-day payment as well as occupancy rate and deficiencies.

Among the auditor’s findings:

The statewide average nursing home occupancy rate stood at 75 percent last fiscal year — ranging from a high of 100 percent to a low of 18 percent. The number of residents has decreased by 1,228 — from 26,563 in July 2011 to 25,335 in November 2013.

The report states that nursing homes are being reimbursed indirectly $16 million annually through the funding formula used. Donchess said nursing home occupancy rates have gone up from 70 to 75 percent in recent years.

Medicaid rates per resident per day have increased 38 percent since June 2010 because of rising costs and the number of residents in poor health increasing. But the report notes the rate is “relatively low” compared to other states. Rates increased from an average $117.19 per day to $161.56 during the period.

From fiscal year 2011 through 2013, Louisiana nursing homes were cited for 7,666 deficiencies, 91 percent of them categorized as “no actual harm with potential for more than minimal harm.”

The report cites May 2011 U.S. Agency for Healthcare Research and Quality data which put Louisiana “far from the benchmark” for several quality-of-care indicators. Among them, the percentage of residents spending most of their time in a bed or wheelchair in Louisiana was 7.3 percent compared to the benchmark 1.43 percent, and the percentage of residents in physical restraints in Louisiana stood at 6.09 percent, compared to the benchmark of 1.35 percent.

The auditor’s report also cites a September 2011 report, “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Disabilities, and Family Caregivers.” That report ranked Louisiana 50th for percentage of high-risk facility residents with pressure sores and 48th for percentage of long-stay residents who were physically restrained.

Follow Marsha Shuler on Twitter, @MarshaShulerCNB. For more coverage of the state capitol, follow Louisiana Politics at http://blogs.theadvocate.com/politicsblog.