Medicare Toughens Standards on Nursing Homes

By Katie Thomas

The star ratings of nearly a third of the nation’s nursing homes were lowered on Friday, as federal officials readjusted quality standards in the face of criticism that the ratings were inaccurate and artificially inflated.

Federal officials said they hoped the changes would make it easier for consumers to differentiate between facilities, as well as spur nursing homes to make improvements.

The changes that took effect on Friday were mainly aimed at one of three major criteria used to rate the homes on the Nursing Home Comparewebsite, which ranks more than 15,000 nursing homes on a one- to- five-star scale. Officials essentially adjusted the curve for the quality-measures rating, which is based on information collected about every patient.

Representatives for the nursing home industry said that rather than helping consumers, the changes could frustrate them.

“Any time that nearly a third of an entire sector is impacted by a change of this magnitude, there will be confusion,” said Mark Parkinson, the chief executive of the American Health Care Association, the trade group for profit-making nursing homes. “We’re not helping patients and their families get the information they can trust when the star rankings don’t match the quality care being delivered.”

Advocates for nursing home residents, however, described the changes as long overdue.

“We think that rescaling the quality measures will result in improved reporting of the quality of care a nursing home may provide,” said Robyn Grant, director of public policy and advocacy at the group Consumer Voice.

Nursing Home Compare has become the gold standard for evaluating the nation’s nursing homes, even as it has been criticized for relying on self-reported, unverified data. The website receives 1.4 million visits a year, federal officials said.

In August, The New York Times reported that the rating system relied so heavily on unverified information that even homes with a documented history of quality problems were earning top ratings. Two of the three major criteria used to rate operations — staffing levels and quality measures statistics — were reported by the homes and not audited by the federal government.

In October, the federal government announced that it would start requiring nursing homes to report their staffing levels quarterly — using an electronic system that can be verified with payroll data — and that it would begin a nationwide auditing program aimed at checking whether a home’s quality statistic was accurate.

Before the change on Friday, about 80 percent of the nation’s nursing homes received a four- or five-star rating out of five on their quality measures score; afterward, nearly half did. The number of homes receiving one star in that area increased to 13 percent, from 8.5 percent, after the recalibration.

The changes led to declines in the quality-measures rating of 63 percent of homes. The staffing scores of about 13 percent of homes also fell because of other adjustments that took effect on Friday.

Federal officials said the higher bar reflected the fact that the industry had improved since December 2008, when the rating system was put into effect.


Falls and Older Adults

Risk Increases With Age

Many people have a friend or relative who has fallen. The person may have slipped while walking or felt dizzy when standing up from a chair and fallen. Maybe you’ve fallen yourself.

If you or an older person you know has fallen, you’re not alone. More than one in three people age 65 years or older falls each year. The risk of falling — and fall-related problems — rises with age.

Falls Lead to Fractures, Trauma

Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries. Among older adults, falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths.

Fractures caused by falls can lead to hospital stays and disability. Most often, fall-related fractures are in the person’s hip, pelvis, spine, arm, hand, or ankle.

Hip fractures are one of the most serious types of fall injury. They are a leading cause of injury and loss of independence, among older adults. Most healthy, independent older adults who are hospitalized for a broken hip are able to return home or live on their own after treatment and rehabilitation. Most of those who cannot return to independent living after such injuries had physical or mental disabilities before the fracture. Many of them will need long-term care.

Fear of Falling

Many older adults are afraid of falling. This fear becomes more common as people age, even among those who haven’t fallen. It may lead older people to avoid activities such as walking, shopping, or taking part in social activities.

If you’re worried about falling, talk with your doctor or another health care provider. Your doctor may refer you to a physical therapist. Physical therapy can help you improve your balance and walking and help build your walking confidence. Getting rid of your fear of falling can help you to stay active, maintain your physical health, and prevent future falls.

Tell Your Doctor If You Fall

If you fall, be sure to discuss the fall with your doctor, even if you aren’t hurt. Many underlying causes of falls can be treated or corrected. For example, falls can be a sign of a new medical problem that needs attention, such as diabetes or changes in blood pressure, particularly drops in blood pressure on standing up. They can also be a sign of problems with your medications or eyesight that can be corrected. After a fall, your doctor may suggest changes in your medication or your eyewear prescription. He or she may also suggest physical therapy, use of a walking aid, or other steps to help prevent future falls. These steps can also make you more confident in your abilities.

Ways to Prevent Falls

Exercise to improve your balance and strengthen your muscles helps to prevent falls. Not wearing bifocal or multifocal glasses when you walk, especially on stairs, will make you less likely to fall. You can also make your home safer by removing loose rugs, adding handrails to stairs and hallways, and making sure you have adequate lighting in dark areas.

Falls are not an inevitable part of life, even as a person gets older. You can take action to prevent falls. Your doctor or other health care providers can help you decide what changes will help.

Insulin Resistance: The Real Reason Why You Aren’t Losing Weight


Many people have weight loss as one of their key resolutions. Sadly, 35 percent of people also give up on that goal before the month even ends. It’s not necessarily lack of time or willpower that causes you to struggle with weight loss year after year. The real reason that you may have struggled to lose weight is insulin resistance, or a condition I call metabolism dysfunction.

So you may be thinking, “Why is it so hard for me to lose weight?” I’m doing “everything right,” and yet still weight loss is difficult. Perhaps (like many of my patients) you’re already following a strict diet and working out several times a week, but to no avail. The weight still won’t come off — or, worse, you are gaining weight for seemingly no reason at all! You have become resigned to being overweight.

Weight problems aren’t a permanent and immovable fixture for the rest of your life. If you’re finding that weight is easy to gain and hard to lose, it’s not your fault! Weight problems aren’t just about overeating or under exercising — they’re about metabolic changes (The MD Factor Diet, 2015) that are collectively known as insulin resistance. Lab tests conducted in my practice have confirmed that over 89 percent of my patients have this real and often undiagnosed issue. So the good news is that the right combination of diet, exercise, and will to succeed you can reverse your MD factor and finally find success in losing weight and keeping it off for good.

In a nutshell, insulin resistance is the inability of your body to properly convert the food that you eat into energy to fuel your cells. People with the MD Factor have difficulty regulating their blood sugar, which is often due to insulin resistance or even diabetes. In both instances, their bodies are unable to pull glucose into the cells, which means that excess levels of glucose build up in the blood. With nowhere else to go, the body turns this extra energy into fat and stores it for later.

This infographic outlines the symptoms and causes of insulin resistance, or metabolism dysfunction.


Surprisingly, you don’t have to be overweight for your cells to be insulin-resistant. Even if your weight is perfectly normal, you can still suffer from its effects. Metabolism dysfunction doesn’t develop overnight and could be caused by one or more triggers including: aging and menopause, genetics, belly/visceral fat, medications, and nutritional deficiencies. We’ll cover all these in subsequent posts. But for now, we’ll cover the two reasons you have no control over — genetic predisposition and aging.

DNA has a big impact on your weight (The MD Factor Diet, 2015). When I was in medical school I read an article that made a lasting impression. It said that if both parents were obese, the child had an 80 percent likelihood of becoming obese. This struck me not only because it’s a staggering statistic, but because my family has always suffered with our weight, I have to be very mindful of my own diet and exercise because I’m genetically predisposed to gain and retain weight.

You may have been born with cells that don’t respond well to insulin. If your family has a history of diabetes (particularly from your parents) you’re at high risk of developing a dysfunctional metabolism. Your genes also determine how your body stores fat (e.g., if you’re apple-shaped, you’ll carry fat in your abdominal area and be at risk of having two contributing factors — genetics and belly fat — to your Insulin Resistance).

Just like we can’t control the genes we were born with, we all grow older. As this occurs, our hormones gradually decline. Declining hormone levels affect muscle mass causing it to be lost first while your body holds onto its fat stores. As you age, you need to be more mindful of what you eat and your physical lifestyle. After all, few of us can eat the same at 50 as we did at 30.

There are several examples of correlation of aging and weight. Pre-menopausal women typically gain 10-15 pounds (though I’ve had patients with up to 30-pound weight gain) around menopause (Women’s Health Research Program, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia). It’s not just hormones like testosterone and estrogen that shift to affect your weight. The body’s ability to use insulin does gradually decline, though it can be slowed by diet and regular physical activity. Type 2 diabetes has been shown to get more prevalent as you age, according to the Centers for Disease Control. Currently, half of all Americans aged 65 years and older have prediabetes. Without lifestyle changes to improve their health and manage Insulin Resistance, up to 30 percent of people with prediabetes will develop Type 2 diabetes within five years.

In order to avoid weight gain, diabetes, and other medical problems (like heart disease) as you age, you need to eat and exercise to minimize the effects of insulin resistance.

Do you have a dysfunctional metabolism?
My patients feel a lot better about their weight struggles once they realize that they’re overweight not because they ate too much or are lazy. Body weight and weight regulation are highly complex and influenced by many different genes. You may have been born with factors out of your control, but you can put that control back in your capable hands.

Where do we go from here?
Insulin resistance is caused by changes in how your body is able to use the nutrients in your food. It’s very common, but not often recognized by those who have it — or their physicians.

If you’ve tried to lose weight and haven’t made any real progress, one thing is certain: Your metabolism has changed. Your old metabolism has been replaced by one that likes storing fat.

Healthy lifestyle and diet is important and can help regulate insulin levels. Exercise can also help the body regulate blood glucose and keep excess weight off.

You may have been born with genetic predisposition to gain and retain weight, but by making a few lifestyle changes, you can reverse the impact of the MD factor. By adjusting your diet and lifestyle, you can eat better, sleep better, have more energy, be sharper and more focused and lower your risk for heart disease, some cancers, stroke and dementia (The MD Factor Diet 2015).