The Centers for Medicare and Medicaid Services maintain a five-star rating system for nursing homes. Those with five stars are considered the best. Gracedale, Northampton County’s nursing home, had a four-star (“above average”) rating in January. But that has gone on a downward slide to just one star, or “much below average.”

That’s its lowest rating. According to both Human Services Director Allison Frantz and Gracedale Administrator Rayond Soto, Gracedale may wear this black eye for as long as a year.

Frantz attempted to attribute this poor rating to increased scrutiny from the Department of Health, which was taken to task by Auditor General Eugene DePasquale for inadequate oversight. But of eight nursing homes within a ten-mile radius, Gracedale is the only one with a one-star rating.

Nitpicking

Cedarbrook, the Lehigh County owned nursing home, has a five-star rating.

“One star is not who we are,” said Frantz. She also attributed the poor rating to what she calls “low level deficiencies.”

Bob Werner also minimized the problem. “They nitpick, if I may use that term.”

The state Department of Health lists 105 surveys for Gracedale online. These “low level deficiencies” include problems like openly displaying computer screens that display a patient’s confidential information, unattended medication carts, forcing some residents to eat meals in restraints, failure to review resident drug regimens, failure to report possible abuse to state authorities and failure to notify family members of changes in a resident’s medical condition. In March, Gracedale was cited after it was discovered that one resident was receiving three times the recommended daily dosage of a psychotropic drug.

Gracedale was also sanctioned with a $2,500 fine by the state Department of Health over numerous missteps in the way the facility responded to an attempted suicide.

Deficiencies

Over the past year, Gracedale has been hit with 15 health deficiencies, which is twice the state and national average.

These deficiencies reflect Gracedale’ poor rating for “quality measures,” which measures things like the use of psychotropic drugs, pain management, bed sores and infections. Gracedale has just one star in this category, which is considered “much below average.” It had this rating through all of 2016 as well as this year.

Antipsychotic use

Most nursing homes, including Gracedale, improperly use psychotropic drugs. At Gracedale, one of every four long-term residents receives antipsychotic medications, and 35 percent of the facility’s long-term population are on anxiety or hypnotic drugs.

A 2011 study determined that 88 percent of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia even though those drugs have never been approved for that use. Federal law prohibits the use of psychoactive drugs when they are just for the convenience of staff. There has to be a documented medical need for the drugs. Otherwise, they are considered “chemical restraints.”

After an effort to sell Gracedale failed in 2011, Northampton County has made changes to help improve the facility. A privatized administrator runs the home. There’s an advisory board made up Gracedale supporters. Council Executive John Brown and council have watched carefully for increases in overtime and other labor costs. Quality measures were never discussed in 2016, and only became a topic of discussion in March. That was after a Council candidate criticized the County’s failure to discuss quality measures.

Reduce drug use

Gracedale Administrator Raymond Soto said the nursing home medical director is working on a new protocol to reduce the use of psychotropic drugs. In a 25-mile radius of the county-owned nursing home, only one facility other than Gracedale has a one-star rating for “quality measures.”

As disappointing as this poor rating is, there’s some good news about Gracedale, too.

First, reimbursements from Medicare and Medicaid are going up. The case-mix index (CMI) is at 0.91, and this is what determines how the nursing home gets paid. Both Soto and Human Services Director Allison Frantz explain that the negative rating has no impact, one way or the other, on reimbursements.

Second, Gracedale will be receiving a $2.2 million IGT, or intergovernmental transfer, from Uncle Sam at the end of June. NorCo Budget Administrator Doran Hamann, known for his fiscal conservatism, has told Council that he expects to see Gracedale break even or make a small profit again this year.