Clarification of Answer by
09 Oct 2005 10:22 PDT
I used the term "fledgling" because these rating companies are only
about twenty years old -- to me, that seemed to make the industry
fairly new! Also, a renewed emphasis on quality of assisted living was
begun during the Reagan and Clinton administrations.
GHS was founded in 1985:
"GHS developed a full-service, comprehensive health survey and
reporting system, initially for Medicare risk contractors, for the
purpose of risk stratification, risk factor reporting and clinical
CareScout was founded in 1997:
"Recognizing a need for consumer-friendly, comparative eldercare
information, Robert N. Bua, the founder of CareScout, drew upon his
nursing home industry expertise to create the nation?s first
quality-of-care rankings and ratings system for every nursing home in
America. Publication of the book The Inside Guide to America?s Nursing
Homes: Rankings and Ratings for Every Nursing Home in the US (Warner
Books) in 1997 provided a platform upon which to establish CareScout?s
parent company, National Eldercare Referral Systems, Inc. ('NERS')."
CarePathways was founded in 1999:
See this report on National Eldercare Referral Systems, Inc. at
Practical Medical Applications (PCAPPS):
The QIs criteria was mandated in 1999. See this January 2003 Office of
Inspector General report "Quality Assurance Committees in Nursing
Homes (OEI-01-01-00090; 01/03)"
"In 1999, CMS introduced the QIs as a new means for nursing homes to
pinpoint quality-of-care issues with data." Reading this report,
you'll also see references to laws and measures pertaining to quality
of care going back to 1987.
Here's some background:
From 1987 through the Clinton administration, government placed an
emphasis on fraud prevention in assisted living, which culminated in
the 1998 initiative "Operation Restore Trust." See this March 16,
1998, press release from CMS (Centers for Medicare and Medicaid
"On January 26, 1998, President Clinton sent to Congress the first
annual report of the Health Care Fraud and Abuse Control Program --
created by HIPAA -- which shows remarkable progress in rooting out
health care fraud and abuse. In FY 1997 alone -- the first full year
of anti-fraud and abuse funding under HIPAA -- nearly $1 billion was
returned to the Medicare Trust Fund. . . ."
Quality care, as much as fraud, was part of that initiative. See this
July 21, 1998 CMS press release:
"The Clinton Administration today announced a new nursing home care
initiative to provide enhanced protections for nursing home residents
and to target specific needed improvement in nursing home care."
See testimony of Keren Brown Wilson, Ph.D. of the Jessie F. Richardson
Foundation, given at a June 11, 2003, FTC hearing: "ASSISTED LIVING:
EVOLVING MODEL FOR A NEW GENERATION OF ELDERLY":
First, we should recognize that efforts taken to implement a strategy
of using consumer disclosure forms have been a step in the right
direction. These efforts were undertaken in response to the 1999 GAO
[General Accounting Office] report as it called for written
information regarding cost, service agreements, discharge criteria,
and grievance procedures provided to consumers before a contract is
signed . . . .
That 1999 GAO report is also cited in this February 2001 report from
the AARP: "Federal and State Enforcement of the 1987 Nursing Home
Reform Act Fact Sheet," written by Bernadette Wright of the AARP
Public Policy Institute:
"The Nursing Home Reform Act of 1987 established quality standards for
nursing homes nationwide, established resident rights, and defined the
state survey and certification process to enforce the standards . . .
"In 1997, the Senate Committee on Aging, chaired by Senator Charles
Grassley, received reports of widespread death and suffering in
California nursing homes caused by inadequate care. In response to
these reports, the Committee held a hearing on California nursing
homes in July 1998.
"A General Accounting Office (GAO) report presented at the hearing
revealed that, despite the requirements of the Nursing Home Reform
Act, weak enforcement put many residents at risk of substandard care.
. .Based on their findings, GAO recommended strengthening federal and
state oversight of nursing homes to better protect residents
throughout the country."
The real boom seems to be in companies, such as Solucient, that rate
assisted living facilities for real estate investors and other
(Unfortunately, many of the links at this page aren't working.)
And in consulting groups that help facilities reach desirable ratings
levels. Just use the search strings:
consultants +nursing homes +directory
assisted living consultants," or "nursing home consultants
health care consulting firms + private pay assisted living facilities
You'll find a plethora of consulting firms with respect to software,
marketing, and consultants who bring facilities up to code and help
them achieve desirable ratings. Many of those quality consulting
groups consist of one person, or just a few people, and most of those
consultants are nurses who have a background in geriatric care.
I hope this additional information is of help.
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