Death caused low BCNH rating: Schumann

Bedford County Nursing Home received the worst rating possible in a study released Dec. 18 by the Centers for Medicare & Medicaid Services, mirroring the state as a whole's lower than average ratings.

Wayne Schumann, nursing home administrator, said the death of a resident last May, which landed the facility on immediate jeopardy status with the state, was the main reason for the low rating. The death came as a result of a resident falling out of a lift chair.

"I expected it," said Wayne Schumann, nursing home administrator. "The death is really what hurt us."

Glen Oaks Convalescent Center, a for-profit center and the only other Bedford County facility rated, received three out of five stars in the overall rating, compared to BCNH's one star. Nursing homes were also rated on specific indicators, based on surveys or health inspections (based on complaints and other data submitted by nursing homes monthly), staffing levels and quality of care.

"Three stars is average," said Schumann, referring to Glen Oaks' overall rating. "They didn't have the incident we did."

Since coming off immediate jeopardy status last summer, Schumann said BCNH has made many changes, including the full-time staff addition of an education nurse, $20,000 worth of new bathing area equipment, two new lift chairs and more thorough training.

"People need to be confident they're going to get good care here," he said.

Across the state

Thirty percent of the 16,000 Tennessee nursing homes rated in the report also received one star. Louisiana and Georgia were the only states which received better scores than Tennessee as a whole.

"If you take these reports and look at (a 50-mile) radius there is a bunch of nursing homes with one star," Schumann said, including Lynchburg Nursing Center, Life Care Center of Tullahoma, United Regional Medical Center Nursing Home in Manchester, Lincoln Donalson Care Centers in Fayetteville, Northside Health Care Center in Murfreesboro, Tennessee Veterans Home in Murfreesboro, Peachtree CTR Nursing and Rehabilitation in Smyrna, Columbia Care and Rehabilitation Center in Columbia, NHC Healthcare in Columbia, Harpeth Terrace Convalescent Center in Franklin, and others.

Statewide, facilities incurred problems on their staffing ratings (more than 41 percent of 319 facilities in the report received the lowest possible score on staffing), where Bedford County facilities received above average scores.

Where BCNH fell short

Schumann said nursing homes are evaluated according to each state's own standards throughout the year, and over the last two years the state of Tennessee has been very stringent, resulting in more health inspections.

"Generally speaking I think (the rating) system is going to be a good idea, but they need to fine tune it," said Schumann, noting there are parts of the rating system that are subjective. "The only problem I see ... is how they weigh their scores."

Inspections, or surveys -- one of three ways in which nursing homes were evaluated to determine their overall rating -- had the heaviest weight. BCNH received only one star here, due to the resident's death last May, whereas Glen Oaks received three stars.

Surveys are conducted annually, and also may be conducted during other times throughout the year at the state's discretion. The federal report was based on as many as three years of surveys for each facility, but the most recent surveys carried the heaviest weight.

Bedford County had its first survey, since the inspection done after the resident died, last month, and has yet to receive that report. In the annual survey prior to the one which landed the facility on immediate jeopardy, BCNH had no deficiencies.

Quality of care

Quality of care was also measured in the report, and both Glen Oaks and BCNH received one star in this category.

"Here they'll look at (bed sores) or restraints" and eight other indicators, said Schumann. "If you have a higher rating than the state or national average you'll get a one star here ... There are some areas we know we need to work on."

Where the county fell short in the quality indicators, according to Schumann, was in medications, which are driven by physicians.

"For example, they don't like you to have people on a lot of medication and so if a doctor orders a psychotic medication for a patient who's truly not psychotic, there's not much we can do about it," Schumann said. "That's one of the problems we've had."

Choosing a nursing home

The bottom line, according to Schumann, is that ratings such as those issued earlier this month should be one of several factors in determining a nursing home for your loved ones.

"This gives people a starting point, but they need to come out and visit the nursing home," Schumann said.

He said it's important to do a walk through, look at the staffing, visit during meal time, look at the room and the overall cleanliness of the facility.

While he feels the ratings were subjective in the areas where the surveys are concerned, he did say the way those surveys are conducted will be changing in the future, bringing much more objectivity to the whole process.