Pennsylvania nursing homes received an “F” from a national advocacy group that rates and ranks states on the quality of its care.
But the head of a trade group representing nursing homes in the state said the report doesn’t account for the full picture of care, including ongoing funding struggles.
Families for Better Care, the Austin, Texas-based nonprofit that produced the report, gave Pennsylvania the failing grade in part due to low staffing across the state.
“What you see in Pennsylvania is chronically low direct-care staffing hours in far too many nursing homes,” said Brian Lee, executive director of Families for Better Care.
Families for Better Care compares and ranks nursing home quality using federal data. These measures include staffing hours, health inspections and severe deficiencies. Severe deficiencies are care lapses that result in or could result in a resident’s injury or death.
“If you don’t have enough direct care staff to care for residents, you’re going to end up with injured residents,” Lee said.
The group has issued reports in 2013, 2014 and this year. Pennsylvania had a “C” in 2013 and a “D” in 2014.
Since the 2014 scores, the grades for 28 states improved. Grades for 19 states, including Pennsylvania, dropped. Seven states – California, Oregon, Pennsylvania, North Carolina, Arkansas, Massachusetts and Vermont – saw their ranking drop by double digits.
A statewide association for the nursing home industry in Pennsylvania took issue with the report, saying it failed to address the flat funding challenges operators face and relied on 2018 data, the most recent available. The Centers for Medicare and Medicaid Services recently changed how it evaluates staffing levels, which previously relied on self reported data.
“They don’t take into account the funding crisis,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which represents 500 members statewide. “Long-term care providers have not seen an increase in funding in the state since 2014. The sector is struggling.”
One in four Pennsylvanians in the next decade will be 60 years old or older, the demographic most likely to need skilled nursing care.
Last week, U.S. Sens. Bob Casey Jr., D-Scranton, and Pat Toomey, R-Lehigh Valley, released a secret federal report showing 400 poor performing nursing homes in need of greater oversight. Sixteen were identified in Pennsylvania, three in Western Pennsylvania. In the wake of the disclosure, CMS has committed to releasing the list of under-performing homes moving forward.
Gov. Tom Wolf’s administration has sought to improve the quality of nursing home care with more robust sanctions since Pennsylvania Auditor General Eugene DePasquale issued a scathing performance review. DePasquale’s 2016 audit was critical of the Health Department’s oversight. It found that the agency lacked the policies necessary to direct state inspectors in how to ensure nursing homes meet minimum staffing requirements.
Pennsylvania statute requires only 2.7 hours of care per resident each day.
The enforcement – Lee argues, pointing to Florida’s B grade and the state’s 2.5 hours of direct care – is as important as the minimum standard.
“You have to have really tough enforcement on top of the standards,” Lee said.
Nate Wardle, a Health Department spokesman, said the agency has stepped up its enforcement, which can often lead to identifying more care deficiencies – something the report examined – but it can also improve care.
“The Pennsylvania Department of Health is committed to holding nursing home operators responsible for providing safe care to residents of Pennsylvania’s nursing homes,” Wardle said in an email to the Tribune-Review.
Wardle added that Wolf has supported safe staffing levels and has urged legislators to act. The governor has brought together a group of representatives from agencies involved in long-term care for older adults to address the needs of nursing homes.