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 Five-Star Ranks Swelling, AHCA Says In New Quality Report

The number of skilled nursing centers receiving five stars from the Centers for Medicare & Medicaid Services (CMS) has nearly doubled since 2009, the American Health Care Association (AHCA) is expected to announce Wednesday.

When CMS launched its rating system, 11.8 percent of skilled nursing centers were given top honors. Today, 19.6 percent of centers have been given five stars, AHCA says in its annual quality report, which will be released Wednesday morning.

“From the fourth quarter of 2011 to the same quarter of 2012, there have been across-the-board improvements in almost all the quality measures generally used in this field,” the report says.

The quality has improved even as the population in skilled nursing centers has declined—and changed, AHCA’s report finds. The overall occupancy rate of a skilled nursing center in 2007 was 89 percent. Today, it’s 86 percent. The population of nursing centers fell by nearly 49,000 residents over the same period, Wednesday’s report says.

Meanwhile, the share of residents in skilled nursing centers who are only there for the short-term has continued to grow, AHCA found. At any given time, 86 percent of patients in a center are long-stay; but the higher turnover of short-stay residents—the average short-term stay is 27 days—means that through the course of a year, there are more than two short-stay residents for every one long-term resident, the report says.

And the acuity for long-term residents also is increasing. More than three-fifths of long-term residents suffer from dementia, Wednesday’s report says.

Nearly all residents (95 percent) need help with at least four activities of daily living, from bathing to eating, AHCA found.

Turnover remains a challenge for providers, but AHCA also found that the number of direct care nursing hours per day has “steadily increased at all levels.” The average number of direct care hours has risen from 3.44 per day in 2007 to 3.68 percent today, the report says.

Those numbers make a difference: A 2011 study found that every additional hour that a certified nurse assistant spends in direct care correlates with a 10 percent decline in deficiency scores at a skilled nursing center. A six-minute increase correlates with a 3 percent decline, AHCA’s report says.

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