Analysis by AARP: Garden State Lags In Quality of Nursing-Home Care

Andrew Kitchenman | June 26, 2014 | Health Care
Ranked 26th nationwide overall, state ranks near bottom for high costs – and next-to-last for patients with bed sores

An AARP report on the nation’s nursing homes ranked New Jersey 26th among 50 states and the District of Columbia, based on an analysis of 26 different indicators that evaluated areas like affordability, choice, quality, caregiver support and the effectiveness of transitions between residents’ homes, nursing homes and hospitals.

The state’s rank declined from the only previous edition of the report, when New Jersey was ranked 22nd in 2011. But AARP officials cautioned that, due to changes in the formula, the rankings aren’t directly comparable.

AARP representatives in New Jersey were disturbed by the state’s performance in some areas, such as ranking 44th in the cost of nursing homes as a share of residents’ income and 49th in the percentage of high-risk nursing home residents with bedsores, trailing only Louisiana and the District of Columbia.

“We found that shocking,” AARP New Jersey government affairs manager Douglas Johnston said of the bed-sore ranking, which wasn’t included in the 2011 report.

But a leading advocate for nursing homes in the state said the industry had made the issue a priority before the report and was making progress. Health Care Association of New Jersey President and CEO Jon Dolan added that the industry is working with Rutgers University on testing that could detect and predict the progression of injuries that can become bedsores.

The report was released shortly before a pivotal period in the state’s five-year comprehensive Medicaid waiver, as the state begins to shift long-term Medicaid recipients to a managed care program on July 1. This is the key feature of the waiver, which is intended to provide more long-term services and supports in residents’ homes and local communities rather than in nursing homes.

The report included some positives. While nursing-homes cost were high in the state, the cost to provide care in residents’ houses was the sixth-lowest in the country. In addition, the state ranked fourth-best in the percentage of long-stay nursing home residents who are receiving an antipsychotic medication.

“While on some individual measures we might have improved, we’re not moving in the right direction” overall, said Evelyn Liebman, AARP New Jersey associate state director of advocacy.

Liebman added that dealing with transitions between living in private homes, nursing homes and hospitals is as troublesome area.

The state ranked 36th in effective handling of these transitions, based on six different indicators. These measures include the percentage of long-stay nursing-home residents hospitalized in a six-month period, and the percentage of residents with moderate to severe dementia who had to undergo a potentially burdensome transition at the end of life. The state ranked 45th in both of these indicators.

“These (transitions) are of course very difficult for the patient and the family, and also quite costly,” Liebman said.

Liebman added that while the high cost of nursing homes is problematic, the state is moving in the right direction with the comprehensive Medicaid waiver.

New Jersey ranked 22nd in caregiver support, which is an area that has been a priority for AARP in New Jersey this year. The organization has backed bills that would require hospitals to ask patients if they want to designate a caregiver who would be provided a plan describing what help the patient will need after discharge, as well as a measure providing a tax credit to caregivers.

“There’s really no reason why we can’t be number one in the country,” in supporting caregivers, Liebman said.

Johnston added that the comprehensive Medicaid waiver might help the state in an area where it ranked relatively poorly, at 40th: the percentage of residents who stay at a nursing home for more than 90 days and then successfully transition back into the community. If there aren’t appropriate, affordable options “that’s going to force them to impoverish themselves and go into a nursing home,” Johnston said.

Liebman said the state is on track to improve in many of the areas evaluated in the report – but it remains to be seen whether planned improvements come to fruition.

“We’re talking the talk – we’re just going to have to see if we walk the walk,” she said.

Dolan noted that the areas where New Jersey ranked poorly were the same as other states with large urban populations, relatively low Medicaid reimbursement rates and a high cost of living, including neighboring New York. His association’s members include assisted living, skilled nursing and other residential care facilities.

Dolan said a larger share of New Jersey’s nursing-home residents have more acute health problems, which contributes to its lower ranking. He added that his association offers frequent training sessions on how to prevent pressure ulcers (or bedsores), and has supported efforts across the industry to reduce the overuse of antipsychotic drugs.

On July 17, NJ Spotlight will be hosting a webinar focused on the AARP report.

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