Sublette Center nursing staff below state average

by Cat Urbigkit

Last week the U.S. government released the results of a quality initiative in which all of the Medicare- and Medicaid-participating nursing homes in the nation were inspected and the inspection results were posted on the Internet, with the Sublette Center included.

The results are posted on the Medicare website at www.medicare.gov under the heading Nursing Home Compare. The site cautions that the quality of a nursing home may improve or deteriorate significantly in a short period of time.

The U.S. Centers for Medicare and Medicaid Services of the Department of Health and Human Services noted the findings of inspections "do not present a complete picture of the quality of care provided by the nursing home. The inspection measures whether the nursing home meets the minimum standard for a particular set of requirements."

One area covered is the amount of nursing home staffing. The Sublette Center has 2.73 nursing staff hours per resident per day, compared to the state average of 4.6 nursing staff hours per resident per day. While the Sublette Center has 43 residents, the state average was 64.4 residents. The Sublette Center's total of 2.73 hours is a combined total of 1.68 CNA hours, .62 LPN/LVN hours and .43 RN hours. The state average of 4.6 includes 2.5 CNA hours, .8 LPN/LVN hours and 1.3 RN hours.

It should be noted that the hours per resident per day is the average daily work in hours given by the entire group of nurses or nursing assistants divided by the total number of residents. The amount of care given to each resident varies.

So in this area - nursing home staffing - the Sublette Center fell below the state average for the number of nursing staff hours.

Sublette Center Director David Doorn said, "I know we're staffed higher than most," and suggested the nursing homes "are filling out this form differently."

Doorn said the nursing staff hours are based on a two-week period in which the survey is received, and for comparison, the last five months would yield a result of 3.23 staff hours per patient, "which I think is realistic."

Doorn said the center cannot be understaffed and have the good quality indicators documented on Nursing Home Compare.

The Sublette Center did well on the quality measures, according to the Medicare site. Information for six of the 10 quality measures is available for the Sublette Center. These measures all deal with chronic care patients (long-term stay residents).

Seven percent of Sublette Center residents have a loss of ability in basic daily tasks, which is substantially less than the state average of 15 percent.

The Sublette Center was on par with the state average with six percent of its residents having pressure sores. The center was less than the state average of 18 percent in its 15 percent of residents with pain. The Sublette Center had no residents in physical restraints, compared to the state average of 9 percent.

Six percent of the Sublette Center's residents had infections, while the state average was 15 percent.

Five health deficiencies were identified in the Sublette Center's inspection. The state average for detected health deficiencies is seven. The highest number of health deficiencies detected in Wyoming was 23.

All of the Sublette Center's five health deficiencies were determined to pose minimal harm and were detected in an inspection of the Center in November 2001. According to the Medicare site, inspectors determined that the Sublette Center failed to make sure that residents receive treatment/services to continue to be able to care for themselves, unless a change is unavoidable.

In the area of resident assessments, the Sublette Center failed to make a complete assessment that covers all questions for areas that are listed as official regulations.

A resident right deficiency identified in the inspection was that the center failed to allow residents to easily see the results of its most recent survey.

Two environmental deficiencies were identified: failure to have a program to keep infection from spreading and to provide needed housekeeping and maintenance.

Doorn said the Center's results were good.

"We'd like to have a perfect survey, but that's not a realistic expectation," he said, adding that the center will correct the deficiencies, document the corrections, "and go on."

Doorn said the results can really vary according to the patient mix in the center at the time. While the center may get a result indicating numerous skin problems, that may be because the timing of the survey coincided with a higher population of end-of-life patients. Doorn's point was that the mix of people in the building can have a direct influence on the result.

The Nursing Home Compare results indicate that the Sublette Center does not have family councils, but does have resident councils. Doorn said efforts to set up the family councils have been difficult to coordinate logistically, especially with family members living out-of-town. The center's quarterly family meetings have not had any regular attendance, Doorn said.

"We're very open to it," Doorn said, "I would love to have it if we could somehow get it worked out."

For overall comparisons with other nursing homes in our region, the Sage View Care Center in Rock Springs had 12 health deficiencies with 2.63 nursing staff hours per resident per day, while South Lincoln Nursing Center in Kemmerer had three deficiencies and 6.5 nursing staff hours. St. John's Living Center in Jackson had three deficiencies, with 4.41 nursing staff hours per resident per day.