Starship KCNH


By Mike Kroll



Earlier this month the Register-Mail ran a story about a federal report released in December regarding the Knox County Nursing Home (KCNH) that began:

“The Knox County Nursing Home has been given the lowest possible rating by a new federal inspection system for nursing homes. Federal Centers for Medicare and Medicaid Services inspectors gave the Knox County Nursing Home 1 out of a possible 5 stars in the new rating system, which was launched this month and covers almost 16,000 nursing homes nationwide. Knox County Nursing Home administrator Marianne Wiesen has criticized the report, which she said does not present an accurate picture of the publicly-funded facility.”

Three days following the January 2nd publication of that news story the same Federal agency released a new report on KCNH which raised its star rating to two-stars for overall quality. The Register-Mail ran a second story on January 24th recognizing this latest monthly rating of KCHN:

“CMS spokesperson Cinthia Michel said the rating system is updated monthly, and, based on new information, the county nursing home has now been awarded a second star. In an interview Friday, Michel could not provide specific details about why the score had been upgraded. ...The county nursing home’s administrator, Marianne Wiesen, declined to comment for this story.”

Wiesen declined to comment because she believed that the Register-Mail had failed to gather the complete story the first time around and it amazed her that no one from the Register-Mail would take her up on her invitation to visit the nursing home and see for themselves the quality of care.

“We have had only a single new admission this month since that original Register-Mail story was published and we don't feel that this scoring system is an accurate reflection of the quality of our facility,” said Wiesen. “I am confident that if someone from the paper had only taken the time to visit the nursing home and meet my patients and staff that they could not possibly leave believing anything at all was substandard regardless of the star rating.”

At the present time there are nine nursing homes rated in Knox County. None have received five-stars; one (Cottage Hospital Skilled Nursing Unit) received four-stars; three received three-stars; four (including KCNH) received two-stars and one received a single star and another critical article in the Register-Mail.

This new five-star rating system is very controversial within the nursing home industry. Paul Langevin Jr., President of the Health Care Association of New Jersey wrote earlier this month, “Five-Star is not simple or consumer-friendly. Its release (both haphazard and premature) has generated as much confusion about which facilities are really 'quality facilities' as any previous rating system developed. ...we have all come to expect that 5-star restaurants and hotels will be far superior to their 3-star counterparts. In the case of nursing homes and this system, that’s not necessarily so.”

In a rating system designed to foster accountability and transparency for consumers the methodology of the five-star system  actually discourages nursing homes from reporting incidents because even a isolated incident report can have a dramatic negative effect on a nursing home's five-star rating. It was a self-reported incident at KCNH that resulted in that initial one-star rating according to Wiesen. Not unlike a restaurant health inspection where a “critical problem” that significantly lowers a facility's score can be easily and quickly resolved this five-star rating system appears unduly sensitive to occassional issues that many knowledgeable people would see as part and parcel of nursing home care.

Wiesen is especially displeased that nowhere in the five-star rating is there are reflection of the satisfaction of patients or their families with the nursing home and its level of care. Langevin agrees and wrote: “Perhaps the most disturbing thing about CMS’ Five-Star rating system is the fact that it has no accommodation to include resident, family or other consumer satisfaction measures. This is not a mere oversight but, in HCANJ’s opinion, a fatal flaw. Shouldn’t we care about what those who currently use nursing home services think about the quality of care that they receive? Isn’t word of mouth and consumer input part of the decision that we make about every other service that we purchase?”

A clearly frustrated Wiesen is concerned about the public perception of KCNH and worried that too much has been made of this new rating system. “We run a very good and caring nursing home at Knox County and I wouldn't have it any  other way. The health and safety and comfort of my clients is the only priority at the Knox County Nursing Home. Just as I offered the Register-Mail the opportunity to come visit us and see for themselves I make that same offer to anyone in the public. I am exceedingly proud of this nursing home and my staff and I am confident that my patients and their families feel the same way.”