Ohio nursing homes lag in US ratings

A new report shows that the quality of Ohio's nursing homes is lower than the national average, though the reason is unclear.

The report, by the Scripps Gerontology Center at Miami University, looked at residents who stay in a facility for 100 days or more. It showed that Ohio ranked below the national average on all 10 of the quality measures used by the Centers for Medicaid and Medicare Services, including instances of urinary tract infections, unexplained weight loss, pain, pressure ulcers and use of antipsychotic medications.

More research needs to be done to find out why Ohio facilities have low quality ratings, said Robert Applebaum, director of the Ohio longterm care research project and a co-author of the study.

The study looks at 2013 data, said Peter Van Runkle, executive director of the Ohio Health Care Association, a nursing-home industry group.

Ohio facilities have improved since then and are now better than the national average on some of the measures, he said, and the association has been working on improving quality of care.

Average use of antipsychotic medications and instances of urinary tract infections, two of Ohio’s lowest quality rankings in 2013, have improved since then, federal data confirmed. Currently, Ohio fares better than the national average when it comes to urinary tract infections, but not for antipsychotics.

The numbers show that the percentage of patients using antipsychotics went from 23.18 percent in 2013 to 21.59 percent in 2017, though the 2017 national average is 18.46 percent for antipsychotics and the 2013 average is 19.85. The best state, which was not identified in the report, had less than 9 percent of patients on the drugs in 2013.

Antipsychotics are often given to people with dementia, which can be dangerous, said Beverly Laubert, Ohio’s long-term care ombudsman. Her office is working on helping professionals try non-pharmacological approaches to dementia care.

“The concern is essentially people are being over-medicated,” Applebaum said.

The report also shows a clear

difference in quality between for-profit and nonprofit facilities. The majority, 79 percent, of Ohio nursing facilities are owned by for-profit companies, which were below the national average in all 10 categories, according to the report.

Part of the reason for that could be that nonprofit facilities have more staff members per patient, Applebaum said.

“More staffing seems to be an indicator of improved quality,” he said. Nonprofits may also be able to supplement their care through philanthropic donations that for-profits don’t have, Applebaum said.

Kathryn Brod, president and CEO of LeadingAge Ohio, which represents nonprofit, long-term care facilities, wasn’t surprised by the differences in forprofit and nonprofit facilities because of what she called the “commitment to mission” and quality among nonprofit facilities.

Nonprofit facilities also “spend a lot of time and dollars on innovation and looking at interventions that are not always traditional approaches,

which have the impact of quality of care,” said Nisha Hammel, director of advocacy at LeadingAge Ohio. She cited as an example a program that works to improve memory through music.

Nonprofit facilities retain any surplus they take in, rather than passing it on to a company or shareholders, and that extra money often goes to additional staff, Laubert said.

Though nonprofit facilities in the state had fewer deficiencies than their for-profit counterparts, even they didn’t “look super great” when compared with other nonprofit facilities in the country, Applebaum said.

“It’s an across-the-board issue,” he said.

With the grim picture of Ohio facilities, Applebaum recommends that families and those who need to seek long-term care in Ohio visit the state’s long-term care consumer guide at https:// www.ltc.ohio.gov/. The site has a rating system and resident feedback.