Paul Wellman

A GOOD HAND: Connie, a resident of the Santa Barbara Convalescent Hospital, enjoys winning a game of Uno. The privately owned, for-profit facility is one of only three nursing homes in the area to get a five-star rating from the Centers for Medicare and Medicaid Services.

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Choosing a nursing home for a loved one is a grim task for families, with piles of information to sift through and a tangle of emotions to contend with. To make the job easier, the Centers for Medicare and Medicaid Services (CMS) unveiled a five-star rating system for America's 15,800 nursing homes in December, modeled after American Automobile Association's worldwide rating of hotels.

Based on a home's three most recent inspections, a list of quality measures-the percentage of residents with bedsores, for example-as well as staffing levels, the ratings condense heaps of data on individual facilities into a simple consumer tool. Of the nine skilled nursing facilities within a 25-mile radius of the City of Santa Barbara, three received the highest "overall" rating of five stars: Santa Barbara Convalescent Hospital, Vista Del Monte, and Casa Dorinda. One facility, La Cumbre Senior Living Concepts, received the lowest overall rating of one star. The rest fell in between the two extremes.

"I'm going to be proud that I got five," said Laurie Shea, who owns and runs the for-profit, 68-bed Santa Barbara Convalescent Hospital. "My staff works really hard and I'm hands-on."

However, alongside its stellar five-star overall rating, which signifies that it is "much above average" in terms of quality, Santa Barbara Convalescent Hospital received just two stars for staffing-that is, a "below average" rating for the average number of hours of care staff devoted to each patient per day. The discrepancy that often occurs between a facility's overall rating and its rating on one of the other measures is the reason Santa Barbara's Long Term Care Ombudsman office isn't crazy about the new scheme. "This system is only one of many tools that the consumer should use in getting good care for the resident," said an ombudsman representative.

The nursing home industry doesn't much like it either. Susan Feeney of the American Health Care Association, an industry trade group, said she felt the system could mischaracterize a difficult and complicated process. "We believe that this oversimplification isn't necessarily in the best interest of the consumer," she said. She would like to see resident and family satisfaction measures included.

That being said, the rating system, which can be accessed on Medicare's Nursing Home Compare Web site, medicare.gov/nhcompare, contains links to individual facilities' inspection surveys, thus allowing consumers to see the specific failings that triggered an average or below average rating. One Santa Barbara nursing home, for example, reported that 53 percent of its long-stay residents had been physically restrained, whereas the national average for physical restraint is just 4 percent of residents.

The staffing hours and quality measures are self-reported by facilities.

Paul Petersen-executive director of Samarkand skilled nursing facility, part of the nonprofit, church-related Samarkand retirement community-said in a written statement that the new system relied too heavily on outdated information. Samarkand's overall rating was two stars, but it received four stars for staffing.

To critics of the use of three-year-old inspection surveys, CMS's spokesperson Jack Cheevers said this: "We're trying to give consumers a sense of what was going on [in a facility] three years ago, two years ago, one year ago. We want to give people a sense of that trend. Is it up or is it down?" A CMS Long Term Care branch manager said greater weight is given to newer inspections and less weight to the older ones.

Nationwide, 22 percent of nursing homes got one star, or "much below average" for quality, and 12 percent got five stars.

Laurie Shea of Santa Barbara Convalescent admitted the day state inspectors came to her facility last year they were "a little bit below" federal staffing requirements, ergo the two-star rating for that measure. Normally they are a bit above the required 3.2 hours per resident per day, she said, at around 3.8.

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