The Oklahoma Health Department is taking the direct approach to measure the quality of the state's nursing homes.
A two-page survey was mailed at the end of December to the 27,000 residents, or the guardians of residents, of state-licensed nursing homes, says Darren Burgess, assistant deputy commissioner of the health department. Each survey includes 28 questions about the quality of life, quality of care and quality of service for residents and residents' overall satisfaction. It includes a comment section.
A sheet instructing residents and their families on what to look for in a nursing home accompanied the surveys.
"I think it's a positive step," says Mary Brinkley, executive director of the state-run Oklahoma Association of Homes and Services for the Aging. "I hope it is taken in a positive light and that people who are happy with the facilities they are using do respond, and not just the people who are not happy."
Brinkley says the survey is needed because the health department grew too cozy with providers. The worst example of that relationship came in May 2000, when former Deputy Health Commissioner Brent VanMeter and nursing home owner Jim Smart were convicted of bribery. A federal judge last month sentenced each man to three years in prison and ordered each man to pay a fine of $50,000.
Since the scandal broke with VanMeter's arrest on May 2, Oklahoma has revoked the Medicaid licenses of six long-term-care facilities, and at least five of those homes have closed since the revocation.
"We have a broken survey (inspection) system because if it worked correctly, the poor performers wouldn't continue to provide care," Brinkley says. "If someone refuses to play by the rules, they should lose their Medicare or their Medicaid (reimbursements) or lose their (state) license. It will shed some light on the poor performers, and the health department can identify those and act accordingly."
Burgess, who started with the health department in July, says he wants the survey to be part of a "score card" for every nursing home in Oklahoma. The score card also would include state inspection reports, actions the state takes against providers and complaints that can be substantiated, says Burgess, a former senior manager of internal audit with Beverly Enterprises, a Fort Smith, Ark.-based provider of skilled-nursing, assisted-living and other post-acute-care services.
Burgess says the score card is part of a state effort to promote nursing home quality.
In other measures, the state agreed to raise the Medicaid reimbursement rate from $63 per patient day to $87. The increased rate was packaged with two measures that made running nursing homes more expensive: The new law boosted the minimum wage for nurse's aides to $6.65 per hour, or $1.50 more than the U.S. minimum wage of $5.15, and set minimum staffing ratios statewide that will require more nursing staff over time.
Survey results will be used to highlight areas in which training could improve provider performance; the health department will look to industry groups to develop the necessary courses, Burgess says.
Elma Holder, founder of the Washington-based National Citizens' Coalition for Nursing Home Reform, applauds the survey and wishes more states conducted surveys. "They're not common, so it's a good place to begin," she says.
Holder says follow-up interviews with residents should be done. Interviews are time-consuming, but the resulting information is worth the cost and effort, she says.
Holder's organization has designed a postcard-quality survey and asked HCFA to require nursing homes that receive Medicare or Medicaid payments to make the cards available to residents and their families at all times so regulators can receive feedback on a continual basis. HCFA has tested the cards in a handful of nursing homes but has not committed to requiring them, Holder says.
Burgess says he hopes at least 50% of the surveys are filled out and returned. State inspectors visiting homes will ask residents if they received the surveys, and volunteers in the ombudsman program will hand out surveys in parts of the state and in homes where the response rate was low, Burgess adds. If the surveys are returned at a decent rate, Burgess says, the results should be published early this year.