Joe Donchess, Louisiana Nursing Home Association director (guest commentary, Dec. 3) made points in his commentary that demand clarification:

He notes that a “substantial number” of Louisiana nursing homes improved their Five-Star Quality Rating between 2009 and 2014 on Nursing Home Compare, a rating system of the Centers for Medicare and Medicaid Services, or CMS.

While nursing homes in Louisiana may have improved their Five-Star Quality Rating, that very rating system has been criticized because it is partly based on self-reporting by the very facilities it rates. Recognizing that the current rating system results in inflated ratings, CMS is revising the rating system.

A recent report by the Center for Public Integrity noted that Louisiana and Arkansas nursing homes had the greatest discrepancies between their nurse staffing reports for Nursing Home Compare and their actual annual cost reports. The revised system will be based on payroll data, not self-reports.

He states that in the past 10 years, the number of nursing home beds has gone from 40,000 to 35,000 statewide. Yet Louisiana remains “over-bedded.” A Louisiana legislative auditor report cited an average 75 percent occupancy rate in 2013.

Despite the reduction in beds and the significant number of vacant beds, Medicaid expenditures for Louisiana nursing homes have increased. In 2013, Louisiana nursing homes received $840 million, or 24.1 percent, of the total Medicaid budget for private providers, making nursing homes the largest Medicaid private provider, ahead of hospitals.

Donchess notes that policymakers are moving in the direction of alternatives to nursing home care. He issues a dire warning: Louisiana taxpayers should be fearful of policymakers’ move to home- and community-based care because these providers are “prone to a particular risk of poor service quality, fraud and even physical abuse.”

Donchess certainly knows about poor service, fraud and even abuse from his own experience with nursing homes. The legislative auditor’s nursing home report notes: “Louisiana ranks at or near the bottom when comparing quality indicators among states.” It states that from fiscal year 2011-13, Louisiana nursing homes were cited for 7,666 deficiencies, of which 44 percent were repeat deficiencies. It refers to approximately $4.9 million in sanctions during that same period.

Without regulation and oversight, any system designed to do good has the potential to do just the opposite. But that doesn’t mean we should abandon home- and community-based services, which people overwhelmingly prefer over nursing homes. It simply means that we need to do a better job of regulation and oversight so the people of Louisiana can have the services they want.

Lois Simpson

executive director, Advocacy Center

New Orleans