Timberlane Health earns average, above average Medicare ratings

Editor’s note: This is the first in a five-part series looking at nursing homes in Union County that are rated by Medicare. Each installment will cover a different nursing home facility and will publish on Sundays. All rating information can be found at Medicare.gov.

Picking up a May 20 edition of the News-Times, staff and residents of Timberlane Health and Rehabilitation were surprised to see a full-page advertisement from Little Rock’s Ludwig Law Firm detailing health and complaint inspection deficiencies.

The advertisement asked anyone who has lived at the facility or had family at the facility in the last five years to contact the firm.

Timberlane Administrator Toni Holderfield said the residents were not pleased when they saw that ad.

“It’s aggravating to me when you have someone who is trying to make a living by what I call ‘ambulance chasing.’ They don’t know what it’s like – some of them never stepped foot in a nursing home,” she said. “This is their home, so when somebody talks bad about their home, they take it personal.”

As of press time Friday, Kyle Ludwig, with the law firm responsible for the ad, did not respond to a request for comment.

After the ad ran, Timberlane resident Dale Shirey, in a letter to the editor published in the June 5 edition of the News-Times, said that he and fellow residents were hurt and dismayed by the content of the advertisement.

And while the issues detailed in the advertisement did occur, according to records on Medicare.gov and the advertisement itself, they have been corrected by the nursing home.

Medicare ratings

Timberlane is a skilled nursing facility that participates in Medicare and Medicaid. As such, they report to Medicare, which assigns ratings based on past health inspections, staffing and quality measures that are determined by Medicare.

Health inspection ratings are based on a facility’s three most recent health inspections and any recent complaint inspections. Any penalties incurred by a facility for severe citations or failure to correct a citation are also included in the health inspection ratings.

Timberlane scored three out of five stars on their health inspection rating, a rating considered by Medicare to be “average.” They were fined by the federal government in February 2017 for $1,991. Holderfield declined to comment on the fine or the reasons behind it, and Medicare records do not list reasons behind why a specific fine was issued. However, an inspection report from February 2017 details a case where a resident who required bathing assistance from two aides did not receive the required help and fell, hitting their head and breaking their leg. According to the inspection report, two aides did help the resident into the shower; however, only one aide was there to help the resident back out of the shower. The aide that was present during the fall was terminated after the incident.

Timberlane had five health citations in their most recent health inspection in May 2017, higher than the state average of 4.5 but lower than the national average of 5.8.

Their citations were for:

• failure to keep each resident’s personal and medical records private and confidential;

• failure to make sure each resident who enters the nursing home without a catheter is not given a catheter and receives proper services to prevent urinary tract infections and restores normal bladder function;

• failure to make sure the nursing home area was free from accident hazards and risks and providing supervision to prevent avoidable accidents;

• failure to properly care for residents needing special services; and

• failure to have a program that investigates, controls and keeps infections from spreading.

Three of the citations were for failures with two patients in varying case mixes, which are groups of statistically related patients that are observed in inspections to compare their care.

Additionally, in February of this year, the home received two citations in a complaint inspection. The citations were for failure to provide appropriate treatment and care according to orders, resident’s preferences and goals; and failure to ensure nurses and nurse aides had the appropriate competencies to care for every resident in a way that maximizes each resident’s well being.

The complaint inspection was in reference to a resident who developed a severe bowel obstruction that eventually resulted in a bowel perforation. Both citations indicated that the deficiencies in care caused immediate jeopardy to residents; the problems were, however, corrected immediately following the inspections, according to Medicare records.

Holderfield declined to comment on the facility’s past inspections.

“Good facilities have bad surveys, bad facilities have good surveys,” she said. “There’s things that don’t always portray on a piece of paper.”

Medicare staffing ratings are based on two measures: Registered nurse (RN) hours per resident per day and total staffing hours per resident per day. Timberlane’s overall staffing rating was three out of five stars, or average.

Timberlane scored two out of five stars on their RN hours per resident per day, a “below average” score. Registered nurses at Timberlane spend an average of 13 minutes with an average of 85 residents per day. The state average is 22 minutes with 79.4 residents, while the national average is 40 minutes with 86.4 residents per day.

“I think a lot of it is RNs are harder to come by in long-term care, and especially in the South Arkansas area,” Holderfield said.

Timberlane’s licensed nurse staff, which includes RNs, spent an average of 95 minutes with an average of 85 residents per day. Nurse aides at Timberlane spend an average of 165 minutes with the 85 residents per day, and physical therapists at the facility spend an average of 3 minutes with the 85 residents per day.

The state average for licensed nurse staff’s hours per resident per day is 83 minutes for an average of 79.4 residents per day. The national average is 92 minutes per 86.4 residents per day, both lower than Timberlane. The only total staffing metric where the state and national averages bested Timberlane was in the physical therapist hours per resident per day, where the state average was four minutes per 79.4 residents per day and the national average was six minutes per 86.4 residents per day.

According to the Medicare website, this staffing information is important because there are no federal regulations dictating the best staffing level for nursing homes. This metric takes into account resident care needs versus staffing levels to calculate its star rating.

Holderfield said that at full capacity, Timberlane can hold 106 residents. Currently, 94 people live there. The number of employees hovers between 115 and 130. Holderfield said Timberlane does not have much staff turnover, averaging about 4 percent.

“Arkansas is one of the few states that have mandatory staffing regulations for our [Certified Nursing Assistants] and nurses. … We always do our best to overstaff according to what the regulations are,” she said.

She said a nurse who recently graduated could start out making about $15 an hour working at Timberlane. With the facility being only 12 years old, she said some people have been working at the home since the doors opened.

Dietary agent Lestine Thurman is one of those long-time employees. She has been working at Timberlane since the closure of the ConAgra (Pilgrim’s Pride) poultry plant almost 10 years ago.

“Everybody works together. It’s good working here,” Thurman said.

A nurse practitioner is at the facility five days a week, Holderfield said. There is also a medical director. Residents may choose their own doctors, however, and Timberlane will provide transportation.

The final metrics measure the quality of care a resident receives from the facility. Medicare collects data from their own claims data, such as bills sent from the nursing home to Medicare for payment purposes, as well as the Minimum Data Set (MDS) national database. The MDS is a resident assessment performed by the nursing home at regular intervals, according to the Medicare website. The MDS measures a resident’s health, physical functioning, mental status and general well-being.

Timberlane scored four out of five stars on the quality measures metric, an “above average” score. In 16 of 24 quality measures calculated by Medicare, the facility outperformed state and national averages. Their best score was on the percentage of long-stay residents who needed and got a flu shot for the current flu season, where they were able to vaccinate 100 percent of the residents who needed it. They performed the worst on the percentage of long-stay residents whose ability to move independently worsened, where 30.7 percent of Timberlane residents’ ability to move independently worsened, up 14.6 percent from the state average of 16.1 percent and up 12.4 percent from the national average of 18.3 percent.

Last November, regulations governing nursing homes and skilled nursing facilities were updated and the current star ratings froze at their pre-update levels. The new regulations include a new surveying process for the homes as well as several provisions for resident independence and rights.

Quality of life

Holderfield said the inspections are a “one week snapshot of what’s going on,” and that the MDS gives a more accurate portrayal of the reality inside nursing homes since it is updated regularly throughout the year.

She said she thinks a better way to measure the quality of a nursing home is to look at the relationships between residents and their caregivers at the facility. She said it’s important to know the residents personally so caregivers can be responsive to needs that may be hard for the residents to communicate.

“It’s about sitting down and talking to your resident and getting to know them and knowing when they’re sad, if there’s a trigger. They may not can tell you that their spouse died at the first of July, but they know when fireworks start happening that that triggers a memory … You have to have that one on one time with them,” she said.

Walking through the facility, Holderfield greeted residents and staff by name and received smiles and “hellos” in return. Some residents’ doors stood open and people could be seen watching television, visiting with their roommates and preparing for the day ahead inside their rooms.

The facility boasts lots of opportunities for recreation – one wall near the central nurses’ station has a large calendar to display the month’s planned activities. Activity director Briana Ellison designs the activity schedule, bearing special holidays in mind.

“Today is National Hot Dog Day, so they had hot dog trivia today,” Holderfield said. Other activities on the schedule included Bible studies, bingo and coffee and lemonade socials, among others.

Residents can have spa days at the on-site beauty shop, which offers manicures, pedicures and hair styling. There is also a dedicated activity room where residents can make their own treats, like popcorn and snow cones, watch movies, browse the small library or play any number of board games.

Shirey, resident council president and the author of the letter to the editor responding to the Ludwig Law Firm advertisement, offered no complaints about the nursing home, saying that he likes “everything” about living at Timberlane.

“I thought it was a cabal against this place and I don’t like that at all because this is my home,” Shirey said about the law firm’s ad.

He has been living at Timberlane for about three and a half years, he said, and in that time said he hasn’t had trouble making friends with his fellow residents and is “real comfortable” living at the home.

“I had been out here a lot of times visiting and I noticed the professionalism and the way they seemed to take care of the residents and it – of course, the building is real nice, good appearance and well built, well constructed – and it just appealed to me,” Shirey said about his decision to move into Timberlane.

He said the staff are “regular professionals” and responsive to resident complaints. The only place the home was lacking, he said, was the food.

“The food? It’s pretty good. … I’m rather picky,” he said, laughing.

Shirey noted that one of his favorite pastimes was watching birds in the courtyard through his window. In the courtyard, several residents’ rooms had birdhouses and hummingbird feeders outside their windows. There are several pets at the home as well – a three legged cat and two rabbits that were just added a little over a week ago.

In the gym, several residents could be seen training with their physical therapists. The wide room included stair steps and a small bridge with handrails alongside some more typical workout machines. In addition to physical therapy, Timberlane offers speech and occupational therapy.

Back in the hallway, a woman caught Holderfield’s attention. The woman asked her to find the keys to the church; she appeared to suffer from some form of dementia. Holderfield reassured the woman, putting her at ease.

Visitors are welcome any time, including pets as long as the owner provides a current shot record. One wing of the facility has a space for residents to spend time with their visitors outside of their rooms – there is a dining area separate from the cafeteria and a large living room that serves as a common room.

Group outings vary from going out to eat, shopping, participating in community events and going to the movies, among other activities. Residents may also request transportation for personal outings – Holderfield gave the example of a man from Junction City who returned home to celebrate his 100th birthday.

Holderfield said it is important to make sure residents feel like they are at home at Timberlane. They decorate their rooms and participate in decision-making about activities and meals.

“We don’t want it to be an institution, we want it to be their home,” Holderfield said. “We want pictures, we want them laughing, we want them participating in things they want to do.”

Caitlan Butler can be reached at 870-862-6611 or [email protected].

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