Two-thirds of Connecticut’s 99 licensed home health care agencies provide average or above-average care, while 19 were rated below average, according to new Medicare five-star rating data.
Just one agency, McLean Home Care & Hospice in Simsbury, received the highest rating of five stars; three agencies, including the Lighthouse Home Health Care in Old Saybrook, received 4.5 stars; and eight received four stars. Nationally, as in Connecticut, a majority of the agencies fall “in the middle” with a three or 3.5 star rating, the data released in late January show. Of the 12,201 home care agencies rated nationally, only 2,512 received five stars.
Patricia Adams, administrator for home care and hospice at McLean Home, said, “Our team is really thrilled” with the five-star rating. “It’s taken a lot of hard work and heart, year in and out.” The agency also received above average patient satisfaction scores.
The new five-star rating system, first unveiled last summer, is based on nine of 29 quality measures, including starting care in a timely manner, educating patient and caregiver about medications, and patient outcomes such as improved mobility in walking, getting in and out of bed, bathing, and no hospital readmission.
As the state’s population ages and the length of time patients spend in hospitals and rehabilitation centers grows shorter, more families and individuals find themselves needing home health care services. The new tools are designed to bring more transparency for consumers tasked with making home care decisions.
“Home health care provides care at the lowest cost setting, compared to hospitals and rehab facilities,” said Deborah Hoyt, president and CEO of the Connecticut Association for Healthcare at Home in Wallingford. “Patients are happiest at home, outcomes are better and quicker, and there are fewer infections. And your own family members are around you. They can be trained how to continue the therapy and perform tasks such as changing bandages.”
But even such a seemingly objective system can be imperfect, Hoyt pointed out. The rating system assesses the cost appropriateness of services, measuring how well providers use money and resources. The system also measures patient outcomes. “Some may never get better or cured, but they may become stable. The rating system may not always allow for that positive outcome to be read as such,” Hoyt said.
The new data also includes for the first time a consumer assessment of care.
On the post-care survey, Hoyt said, “This part is based on human perception, and some people are harder scorers than others.”
“Connecticut is a very tough state to do business in” because of its stringent regulation of home health care services. There’s also a lot of economic disparity that influences the kind and quality of care patients have access to. Given all that, Hoyt said, Connecticut home care agencies are in line with others nationally.
Lee Bridgewater, administrator of the 4.5-star Lighthouse Home Health Care in Old Saybrook, said the ratings are of particular use to people from out of town or out of state who are researching options for their aging parents. Reviewing the ratings allows them to learn, for instance, “how quickly care is initiated after discharge from the hospital,” she said. “That’s one [of the criteria] that helped us get the 4.5 stars.”
Bridgewater said of the rating system, “We take it very seriously and work hard to maintain our rating. That’s a real team effort on the part of the staff, and it reflects on the quality and hard work we do.”
"If you want to demonstrate that you provide quality care, but you don't improve while other providers do, your star rating will slip."
Kate Jones
Mark Appellhof, director of sales and marketing for Visiting Nurses of the Lower Valley, said receiving a 4.5-star rating gives the agency “bragging rights.”
“When you’re matched up against the competition and you get recognition like that, you toot your own horn,” Appellhof said, adding that he will incorporate that distinction in his outreach to referral sources such as hospitals and physicians.
Appellhof said that the agency posts its rating in the lobby “so as the public and nurses come in, they see how we’re doing.”
“Of course, as with any measurement tool, there’s going to be some subjectivity to it. But as an overall barometer of how an agency’s doing, it’s fairly accurate,” he said.
Adams said, “The star rating system not only lets consumers see that we’re at the top of our game, but it also tells our team what they have to do to stay there.” For instance, Adams said, data recently revealed “a few more readmissions over the past quarter,” a cause for concern that the agency is taking steps to remedy. “We’re constantly trying to look at the numbers and how we can improve,” she added.
Kate Jones, chief clinical officer at Amedisys in Baton Rouge, La., whose Stamford facility received a four-star rating, said consumers are starting to use the Internet to access rating information. She noted that a patient who used Medicare.gov to compare home health care agencies found that Amedisys was among the best rated in the area.
“I promise you that the staff in Stamford is working toward five stars,” Jones said. “That’s what Medicare intended—the rating system is a quality improvement effort. If you want to demonstrate that you provide quality care, but you don’t improve while other providers do, your star rating will slip.”
In the end, Jones said, the star rating system makes for “a better informed consumer who is ready and willing to be engaged in their own care. That sets us up for success.”
New federal datashow Connecticut has 86 Medicare-eligible home health providers, the second highest number in New England after Massachusetts. Most providers are concentrated in western part of the state, with only seven in Windham County and 10 in Tolland County. New Haven County has 42, Middlesex County, 20.
This story was reported under a partnership with the Connecticut Health I-Team (c-hit.org).
