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Raleigh, North Carolina
United States
Raleigh, North Carolina
United States
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AARP State Office Staff
AARP State Office Staff
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Issue: Consumers need information about how well adult care homes are providing quality care so they can make informed decisions about placement in these homes.
AARP Position: AARP supports the rules for a rating system of adult care homes as adopted by the N.C. Medical Care Commission. The rules were later adopted by the N.C. Rules Commission; however, ten letters objecting to the rules were submitted by representatives of the N.C. assisted living industry which sends the issue back to the General Assembly for consideration in the Short Session. If the General Assembly fails to pass legislation in the Short Session, the rules move forward and go into effect in 2009. AARP does not support legislative action that would change the rules.
Background: The rules adopted by the Medical Care Commission create a star rating system for adult care. The ratings are to be based on the following:
· Inspections and complaint investigations conducted by the Department of Health and Human Services to determine compliance with licensing statutes and rules.
· Type A penalties (the most serious), Type B penalties, and Citations (least serious) imposed on the facility by the Department.
· Corrections to the above cited penalties and citations.
Ratings are based on a 100 point scale and correspond to zero to four stars as shown below:
- Four stars – any facility whose score is 100 points or greater on two consecutive annual inspections.
- Three stars – for scores of 90 to 100 points.
- Two stars – for scores of 80 to 89.9 points.
- One star – for scores of 70 to 79.9 points.
- Zero stars – for scores of 69.9 or lower.
Starting with 100 points, facilities lose points for:
- 2 point loss for each citation of noncompliance with the statutes or rules.
- 10 point loss for each Type A violation.
- 3.5 point loss for each Type B violation. If the Type B violation remains uncorrected after a re-inspection, the facility loses an additional 3.5 points.
- 10 point loss if the facility’s admissions are suspended (unless they are suspended for failure to file cost reports).
- 31 point loss if the facility receives a notice of revocation against its license.
The facility gains points for:
- 1.25 point gain for corrected citations of noncompliance which are not related to Type A or uncorrected Type B violations.
- 1.25 point gain for corrected citations based on a follow-up inspection for facilities that did not have any Type A or Type B violations.
- 2.5 point gain for correcting a Type A violation, and a 2.5 point gain at the next annual inspection if no further Type A violation is identified.
- 1.25 point gain if the facility corrects a previously uncorrected Type B violation.
- 5 point gain if a facility’s previous admission suspension is removed.
- 2.5 point gain if the facility participates in any quality improvement program approved by the Department.
- 2.5 point gain if the facility receives NC NOVA special licensure designation.
- 1 to 2 points for having back up electrical generator capability.
- 2 to 3 points for having automatic sprinklers in good working order.
The rating will include a breakdown of the points added and subtracted in making up the numerical rating, and posted in a location visible to the public.
Support for the Star Rating System: In addition to AARP North Carolina, other organizations supporting the rules include Friends of Residents in Long Term Care, the NC Regional Long Term Care Ombudsman Association, the NC Association on Aging, the NC Adult Foster Care Association, the NC Adult Day Services Association, AMVETS, the Mental Health Association of NC, NCPIRG, the NC Chapter of the National Association of Social Workers, and the NC Justice Center.
Opposition to a Star Rating System: The N.C. Association of Long Term Care Facilities and the N.C. Assisted Living Association have expressed opposition to the rules.
Relevant Information from AARP Poll: In March of 2007, AARP North Carolina commissioned a poll of registered voters in the State on several issues before the N.C. General Assembly, including the star rating system. 78% of those polled indicated they were in favor of a rating system for adult care homes.
Key Facts on Proposed Star Rating System:
- Adult care homes ratings are to be based on meeting minimum State licensure standards (what homes should be doing). This is determined by regular inspections of homes conducted by the State. Areas addressed in the standards include:
- admission and discharge procedures
- medication management
- physical plant
- resident care and services, including food service, resident activities programs, and safety measures
- resident rights
- sanitation grade
- special care units
- use of physical restraints and alternatives
- The rating system does not require any additional work by the adult care home nor does it place any additional regulation on the home. A home’s rating is based on their regular inspection which is already required by law.
- The rating system does not change the State’s standards for adult care homes.
- Consumers need the rating system to help them make more informed decisions about placement in a home. Consumers do not have public information readily available about the quality of adult care homes as is already available about nursing homes, home health agencies, and hospitals which is provided by the federal government. Consumers often have to made quick decisions about placement in adult care homes and without some basis for evaluating homes, they do not have a starting point for making an informed decision.
- The rating system will not put homes out of business; however, if a home is not meeting minimum State standards, its rating will reflect that. If consumers have choices about placement options, a home’s rating may be a factor in the decision of which home a consumer chooses.
- North Carolina has had a rating system in place for child care centers for many years. This has resulted in a better quality of child care throughout the entire state. It is envisioned that a rating system for adult care homes will likewise elevate the care provided by homes across the state.
- In the rating system proposed, every adult care home starts with 100 points for meeting minimum standards. Demerits are deducted for citations of noncompliance with statutes and rules, including citations of Type A and Type B violations. Merits are awarded for correcting citations and violations as well as for participating in quality improvement programs, having a generator, and having an automatic sprinkler system.
A Type A violation is defined as a condition or conditions that have resulted in death or serious physical harm to a resident or are likely to result in death or serious physical harm. Examples of Type A violations are:
· A confused resident who is not properly supervised wanders away from a home and as a result suffers serious harm or death.
· The wrong medication is given to a resident and he/she suffers strong adverse affects.
A Type B violation is an identified condition which impacts the quality of care of the residents in an adult care home. Examples of Type B violations are:
· Criminal background checks are not done on staff.
· Residents do not receive medication as ordered.
· Personal care staff are not tested for tuberculosis
· Staff do not have CPR training.
· Staff can not effectively execute procedures in response to a fire drill.
Added: April 28, 2008
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