So, why should your clients try to plan ahead to pay for long-term care (LTC) services themselves, instead of just planning to depend on Medicaid nursing home benefits?
One reason is that patients who can pay for their own care — whether with long-term care insurance, life insurance, an annuity, or ordinary savings — may have a better shot at getting good care.
A few weeks ago, we ran an article looking at one high-level nursing home quality indicator: the average amount of federal fines per certified nursing home bed, over a three-year period.
(Related: 15 Worst Cities for Nursing Home Quality)
Here’s another way to size up LTC provider quality: a look at the percentage of high-risk nursing home residents in a community who end up getting bedsores.
For the 560 communities we ranked, the average community bedsore rate ranged from less than 1%, in Marshfield, Wisconsin, up to about 11.7%, in one community in Indiana. The median was 5.6%.
For a list of the seven cities with the worst bedsore rates for high-risk nursing home residents, see the data cards in the slideshow above.
(To reveal the slidebox control arrows: Hover your cursor over the slideshow box.)
What are bedsores, and why do they matter?
Bedsores, which are also known as pressure ulcers, are areas of damage to the skin, and the underlying tissue, that are the result of some combination of pressure and friction.
In nursing homes, people may get bedsores partly because of factors such as skin conditions resulting from age-related problems with eating and digesting food. But, in some cases, people get bedsores because they have a hard time moving themselves, and workers fail to turn those people often enough to prevent bedsores from forming.
The federal Agency for Healthcare Research and Quality has reported that bedsores affect 2.5 million U.S. patients of all kinds per year. Bedsores lead to about 60,000 U.S. deaths pr year, and about 17,000 U.S. lawsuits per year.
Analysts at an arm of CNA Financial reported, in a review of claims paid by CNA’s skilled nursing facility liability insurance program, that pressure ulcers were one of the top causes of nursing home liability claims in 2016. The average amount paid for claims involving pressure ulcers affecting nursing home patients was about $232,000.
We created a city-by-city ranking of nursing home resident bedsore rates by using pressure ulcer prevalence data from the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare program.
The CMS Minimum Data Set (MDS) spreadsheets containing that data are available here.
The spreadsheets are free and in the public domain. Financial professionals who are comfortable with filtering and sorting big Excel spreadsheets can use the spreadsheets to create their own rankings and community LTC profiles.
We based our bedsore rate rankings on the four-quarter average bedsore rate for high-risk patients, for communities with at least five nursing homes in the MDS spreadsheets. The MDS pressure ulcer rate refers to long-stay patients with pressure ulcers that involve broken skin, not just inflammation.
CMS uses the term “city” to refer to what a nursing home puts in the city field on its provider information form. In many cases, for legal purposes, the “city” may officially be a town, village or some other type of place, rather than a city.
— Read Liability Costs Driving Up Long-Term Care Bills, on ThinkAdvisor.