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YOUNGSTOWN, Ohio (WKBN) – Nancy Thayer’s mom just wanted to watch the bunnies. But they wouldn’t let her.
At least that’s what Nancy says, claiming that while her 92-year-old Navy-veteran mother Margaret Aiello was a resident at Hampton Woods Nursing Home in Poland, the staff there would not let her go outside when she wanted to and failed to give key medical information to her primary care doctor.
“My mother was a wanderer. She had a purpose, and that was to go outside, socialize, sit and watch bunnies, butterflies. For God’s sake, it was summertime, the weather was nice,” Thayer said.
Thayer said she thought the nursing home violated her mother’s rights. Hampton Woods moved to evict Aiello in September 2014. Thayer appealed the eviction; an arbitrator with the state of Ohio decided against her, and she says she plans to file a complaint with the state. For now, Thayer’s mom has been moved to a new nursing home as she appeals the state’s decision.
Medicare gave Hampton Woods a rating of two stars out of five in its most recent evaluation of the nursing home.
A manager representing Hampton Woods declined an interview with WKBN and sent a statement regarding Aiello’s eviction, noting that their organization cannot comment on the incident due to the Health Insurance Portability and Accountability Act, or HIPAA.
The statement reads, in part:
Hampton Woods wishes to note that it has policies and procedures in place to assist the facility in complying with all applicable federal and state laws and regulations governing Ohio skilled nursing facilities, including those concerning transfer and discharge, and that it is currently in compliance with all such requirements.
Conflicts with area nursing homes, such as the one Thayer experienced, may not be all that uncommon. According to a WKBN investigation, just over 72% of all nursing homes in Trumbull, Mahoning and Columbiana Counties received one or two stars on a five-star scale in their current Medicare review as of May 12. Nursing homes with one or two stars are approximately in the bottom 43% of all nursing homes in Ohio, according to Medicare’s ranking system.
Ohio Healthcare Association President Tim Chesney gave three reasons that those ratings may not accurately reflect the quality of care at homes in the area:
- Medicare grades all the nursing homes in a state against all the other nursing homes in that state, Chesney said. That means that a one-star nursing home in Ohio has one star because it is found to be approximately in the bottom fifth of the state’s rankings.
- Chesney also noted that some of the measures used for nursing homes are subject to human interpretation and could thus be less-than-consistent.
- Finally, a home could be several points away from a three-star ranking but still receive two stars, according to Chesney.
“I don’t think that the ratings necessarily reflect the quality provided in the facilities, although it would be specific to the facility,” Chesney said. “I don’t know that I would say that they are all providing excellent care, but I don’t think the five-star rating system is enough for me to draw the conclusion that they’re all providing poor care.”
According to Chesney, Medicare’s system for grading nursing homes is complicated, but is based on inspections done by individual states and on how the nursing homes perform in three areas: health inspections, staffing and quality measures. The “quality measures” component is meant to be a rating of how well nursing homes care for patients’ needs and is based more on patient outcomes than the other components.
Dr. Milton Yarmy, 103, is currently a resident at Heritage Manor in Youngstown, rated by Medicare as a five-star facility. He knew what he wanted when it came time to choose a residence.
“It was clean. There was no odor. It was about the only one,” Yarmy said.
Yarmy was a member of Heritage Manor’s board when the home originally opened. Current Heritage Manor Executive Director Gary Weiss has nearly four decades of experience working with nursing homes and says Medicare’s rating system is not fail-safe.
“The 5-star is something to consider because that has something to do with quality, okay?” Weiss said. “But it’s not the only thing that should be considered.”
One big focus in nursing home care right now is shifting from a one-size-fits-all approach to a model of “person-centered care,” according to Area Agency on Aging Ombudsman John Saulitis. That term is used by professionals in the business to refer to how well a nursing home places emphasis on providing seniors with what they want.
Saulitis gave the example of a nursing home not wanting to build a whirlpool for a resident for an elderly woman, since she was the only one requesting it, as an example of a lack of person-centered care. Other such examples include allowing residents to choose when and what they eat, what sort of activities they do and so on.
“We should all strive for excellence,” Saulitis said. “And that’s why working toward person-centered care is really a matter of culture change…if the culture has changed, if the will is there, then people will find a way to achieve even the more expensive changes.”
Making that change could be very important for a growing segment of the population, according to the Area Agency on Aging, which says that at least 22% of residents in Trumbull, Mahoning and Columbiana Counties were over the age of 60 as of 2010, and expects that number to grow by 2020.
But how do you tell in advance if a nursing home is a good place for your loved one? After talking to Saulitis, Chesney and Thayer, WKBN compiled a few tips:
- Talk to your local Area Agency on Aging (AAA) to see if your loved one even needs to be in a nursing home. Often, there are more resources available than you might think.
- If you decide your loved one should be in a nursing home, look at online rankings like those provided by Medicare and Ltc.Ohio.gov, but don’t rely solely on them. Saulitis agreed that 72% of nursing homes being below-average means there is room for improvement, but is not the last word on the quality of care in the Valley.
- Walk through the nursing home and pay attention to the sights and sounds first. If it sounds like people are upset or not being taken care of, that isn’t a good sign.
- If your loved one is already in a nursing home and you see things that make you uncomfortable, contact your local AAA.
- Read any contract you sign with the nursing home and understand it thoroughly. Know what rights nursing home residents have under Ohio law.
Chesney and Saulitis agreed that perhaps the most important part of care for the elderly is talking about end-of-life care and doing so early. Having conversations about long-term care, where to live, and who should make key decisions in case an elderly person cannot make them can save a lot of heartache in the long run.
“I think one of the important things is simply not to be afraid of the conversation,” Saulitis said. “That does include a presumption of communication within the family, which is not always the case. If there’s estrangement in the family, all of a sudden, if you show up out of the blue and start asking questions, your mom or dad may start thinking, ‘What are you asking me for, are you after the bank account?'”
In the meantime, Nancy Thayer sees room for improvement in Ohio’s nursing home system.
“The whole system has just fallen apart,” Thayer said. “You can go on and on and on, but if you’re going to make laws and regulations, people need to abide by them.”
See the interactive chart below for more information on local nursing homes, plus their responses when asked by WKBN about their ratings: