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Nursing home regulators, industry officials say ratings no substitute for on-site visits

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On paper, Valley Eldercare Center in Grand Forks seemed to have a big problem.

Over the past three years, it received 20 health inspection deficiencies from regulators. Last year alone, it received eight deficiencies, higher than the state average of 5.6 and the national average of 6.8.

The deficiencies affect the number of stars Valley Eldercare gets in its rating, but officials at the facility and regulators say such marks can be misleading.

“You can have a lot of deficiencies, but they can be easily corrected and maybe not always related to care,” said Joan Ehrhardt, long-term care ombudsman at the North Dakota Department of Human Services. “It’s just one tool.”

Full descriptions of the deficiencies are detailed online at Nursing Home Compare, a public database that rates the quality of nursing homes nationwide in categories such as health and staffing. The site is offered through the Centers for Medicare and Medicaid Services, the national medical and insurance programs, and compares facilities with others in within each state.

Other facilities

Nursing homes are awarded up to five stars based on their success in three categories: health inspections, staffing and quality measures, which rate how well the home cares for residents’ needs. The facilities are only compared against others within the same state.

Valley Eldercare’s ratings depict it as a largely average nursing home. While the number of staff it provides for the 212-bed facility is above average, the facility’s quality measures are average and below average in health inspection deficiencies, the most common weakness among many facilities. If the severity of the deficiency is intense enough, facilities can be penalized by the state and federal government. Valley Eldercare has not received any penalties or fines.

Less than half of the 44 nursing homes found within a 100-mile radius of Grand Forks received low marks from health inspections.

In North Dakota, Manor Care Health Services in Fargo was given the lowest overall rating in the state, though it scored above average in quality measures. Twenty-three other facilities were rated much above average, including Woodside Village in Grand Forks, which received average or much above-average rankings in all categories.

In Minnesota, more than 100 facilities received much above-average rankings, including Karlstad Healthcare Center in Karlstad and Pioneer Memorial Care Center in Erskine. Thirteen facilities in the state received the lowest overall rankings, including Jourdain/Perpich Extended Care Facility in Red Lake.

Garth Rydland, president of Valley Memorial Homes, said consumers should be careful of reading too much into the rankings. One of the limitations of the system is that “a two-star facility in one state could be considered a four-star facility in another.”

His organization oversees Valley Eldercare.

Valley Eldercare

Nearly all of Valley Eldercare’s deficiencies, accrued over a three-year period ending last year, were considered isolated and minimally harmful.

The deficiencies included not resolving resident complaints quickly to not informing the family fast enough about changes in a resident’s condition, such as the formation of a pressure ulcer. In one case, staff failed to review and revise the health care plans for three of 27 residents.

Last year, Valley Eldercare received its most serious-sounding mark. In the report, inspectors advised the center shouldn’t hire people with any history of abusing, mistreating or neglecting residents.

Kathy Dubuque, director of nursing, said the label is deceiving. In this case, she said, a nurse noted on a chart that a patient had a bruise but didn’t inform the care coordinator, so the care coordinator didn’t know why the bruise appeared at the time of the inspection.

“It wasn’t that we hired somebody who was abusive, it was because we didn’t follow up on an injury like that,” she said.

Site visits

Medicare states consumers should remember that a facility’s quality can improve or decline in a short period of time, and this could be due to ownership or financial changes within the home.

Deficiencies do not mean a center is corrupt, and it’s not the only way to judge quality, Ryland said. Nursing homes are about the quality of care, but also about the quality of life, he said. 

“I think (the website) is the best way the government has put some information in the hands of consumers about some things to ask about when they go to a nursing home,” he said. “But personally, there’s no substitute for talking in and visiting with staff.”

Ehrhardt agreed. She said you can often tell how good a facility is just by visiting and talking with staff.

On the web: Nursing Home Compare can be found at

Tips for finding the best nursing home

Joan Ehrhardt, long term care ombudsman at the North Dakota Department of Human Services, offered a few good tips on how to find the best nursing home. 

  •  Observe. Is the home welcoming? Are residents well-groomed? Is there enough staffing? She said you can often tell how good a facility is just by visiting and talking with staff.
  •  Response time. Check to see if the call lights are responded to within 15 minutes and find out if a physician actually visits the facility, she said. In the past, residents could retain their doctor if they moved to a nursing home, but today, only certain doctors will do that, she said.
  •  Food. What a resident eats becomes a very important part of their life, and for some people, it’s the only thing they have to look forward to, she said.
Jennifer Johnson

Jennifer Johnson is the K-12 education reporter for The Grand Forks Herald.  Contact her if you have any story ideas or tips and visit 

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