"We're dealing with a very challenging environment," but Ohio's 970 nursing homes generally support the state's new quality initiative, in part because most will qualify for new, quality-based incentive payments without much trouble, said Peter Van Runkle, executive director of the Ohio Health Care Association.
The threshold for receiving those payments has been the most controversial element of the state's plan.
"It just doesn't seem that (nursing homes) will have to stretch themselves enough, and I'll be advocating for raising the threshold in the future," said Beverley Laubert, Ohio's long-term care ombudsman. Initially, she had advocated that homes meet 15 of 20 standards, a goal that many would have found difficult to achieve.
State officials say it was important to start with a program that the industry would accept and that would not penalize large numbers of nursing homes. "Our plan is to up the ante" over time, said Kantor-Burman.
Ultimately, Ohio's program will depend on institutions such as Welcome Nursing Home in Oberlin, a 102-bed facility operated by the same family since 1945. Jill Herron, the administrator, said her facility will meet 18 out of 20 standards, but she questions how well those requirements reflect quality care.
Take the standard specifying that at least 50% of Medicaid-certified beds be in private rooms. The Welcome home has only six rooms of this type.
"Private rooms may be essential for market choice — people may want them and like them — but I don't think they're essential for quality care," Herron said.
Irene DuRell, an 82-year-old former nurse, has lived at the Welcome home for the past year with a 90-something roommate she calls "wonderful."
Asked what she likes best about Welcome, DuRell said, "They've been real good about helping out when I needed it. And they listen to me."