Heartland Living nursing home review

2015 REVIEW: Heartland Living has fallen from a 4 star nursing home all the way to 1 star. 1 star is classified as "Much Below Average". The staffing levels at Heartland Living are 2 stars:

Heartland NC
Total number of residents 99 87.2 87.4
Total number of licensed nurse staff hours per resident per day 1 hour and 9 minutes 1 hour and 39 minutes 1 hour and 40 minutes
RN hours per resident per day 31 minutes 46 minutes 50 minutes
LPN/LVN hours per resident per day 38 minutes 53 minutes 50 minutes
CNA hours per resident per day 2 hours and 55 minutes 2 hours and 24 minutes 2 hours and 27 minutes
Physical therapy staff hours per resident per day 4 minutes 6 minutes 6 minutes

As you can see from the above chart, the CNA staffing looks good at 20 minutes over the state average. However, the RN levels are only 31 minutes which is much below the 46 minute NC average. (The far right is the US average) The LPN levels are also low. The Heartland nursing home provides almost 33% less nurse staffing than the average home in NC, which is not enough.

Quality Measures- got 4 stars or above average. Heartland deserves at least this 4 and probably a 5 for these good scores. They got 100% of pneumonia vaccines done and no residents in restraints. Overall their quality measures are very good.

Health Inspection- they got 1 star. The reason is that Heartland was found to have 9 deficiencies and the average in NC is only 4. You can see the full inspection report here. One of the complaints was for not answering call bells. If you have ever been to a nursing home, you know what a huge problem this can be.

Conclusion- during the last review, I noted that Heartland was ranked far too high at 4 stars. Now, Heartland is the lowest rank of 1 star. Perhaps that is too low of a rank for this home. The Heartland quality measures look good. The CNA staffing levels have increased. However, the extremely low RN and LPN numbers just don't look good. Heartland deserves 2 stars as a below average facility. With lower skilled staff like RNs, medication errors often increase and residents aren't assessed in a timely fashion. So, you will need to watch for over-medicated residents, dehydrated residents, etc.

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2013 REVIEW: Heartland Living & Rehab at Moses Cone hospital is currently (2012) a four star facility overall . This shows a weakness of simply relying on the overall ratings. If you look at the staffing rating, it is one-star. Which is more important? The overall rating comes from a variety of factors. If the facility has a few good surveys with a small number of deficiencies, their overall rating will improve.So, that is usually only one or two days a year and the state (DHHS) doesn't really look very deep into the care being delivered. The state is somewhat understaffed, and many times takes the chart at face value. For example, if the staff charted that three meals were given, then the state will usually accept that. On a side note, I have put together a Ranking and Review for Greensboro area nursing homes if you would like to compare this home to other nursing homes. Staffing level is the key indicator of good care at a nursing home. Let's look at Heartland's staffing:

HEARTLAND LIVING & REHAB AT THE MOSES H CONE MEM H NORTH CAROLINA AVERAGE NATIONAL AVERAGE
Total Number of Residents 97 88.9 88.2
Total Number of Licensed Nurse Staff Hours per Resident per day 1 hour
2 minutes
1 hour
36 minutes
1 hour
36 minutes
RN Hours per Resident per Day 20 minutes 45 minutes 47 minutes
LPN/LVN Hours per Resident per Day 41 minutes 52 minutes 50 minutes
CNA Hours per Resident per Day 2 hours
28 minutes
2 hours
25 minutes
2 hours
27 minutes
Physical Therapy Staff Hours per Resident per Day 5 minutes 7 minutes 6 minutes

Staffing- Staffing levels reflect the ability of the nurses in the facility to meet residents' needs. Most for-profit nursing homes are understaffed. The nurses and CNAs do the best that they can, but often they fail to provide basic care. At Heartland Living, they have somewhat of an imbalanced staffing ratio. Heartland Living only provides 1 hour and 2 minutes of licensed staff hours per resident per day. The average number of licensed nursing staff per patient day in NC is: 1 hour and 36 minutes. The average of licensed staff in NC is 50% higher than in Heartland Living. Since most nursing homes are already understaffed, Heartland may have too few skilled nurses. For comparison, this level of skilled staffing at Heartland is the lowest in Guilford County, falling behind Adams Farm Living which is a one star facility for staffing.

Even worse, the number of RNs is far lower. Heartland only provides 20 minutes of RN hours per patient day. The average RN hours is 45 minutes. So, this is less than half of the average. It will be nearly impossible for this low number of RNs to get to all of the residents. The LPN numbers are below the average also. The CNA staffing numbers are right on the NC average. What this can mean is lack of skilled nursing oversight. Nurses develop care plans, monitor residents, administer medications, check for changes in condition, etc. With a very low skilled nursing numbers, problems often occur. In facilities with inadequate skilled nursing, you will often see medication errors as the nurses are too busy. You will see undiscovered pressure sores, weight loss not being addressed, dehydration etc. CNAs don't have the training to perform nursing assessments and will often miss these problems. Also, nurses will help supervise CNAs and make sure they are doing their jobs properly. Ultimately, this may cause some problems with residents at Heartland Living.

If you have any questions regarding nursing home staffing issues, please contact me. Our firm does handle nursing home abuse and neglect cases. However, my goal with this blog is to provide information. I already get plenty of cases. My hope is that by giving you some information, you can make informed decisions as to what are the good and bad nursing homes. Also, I hope that nursing homes will start paying better attention to their staffing numbers. Until the public becomes knowledgeable, they will not change.

Quality Measures Addendum- I decided to look into some of the quality measures for Heartland, and they are pretty good. Generally, the residents report lower pain levels than other homes, lower use of antipsychotics, and have very few falls. The facility has less than one-third of the state average of falls with major injury. Catheter use is lower. With these strong quality measures, I do understand why it is a four star facility. However, I hate to beat a dead horse, but staffing levels is the primary indicator of quality care. If you have someone in Heartland, just make sure to insist nurses check on them while you are there. Look for residents losing weight, trays being left uneaten, residents being left wet or dirty, etc. In nursing homes, "the squeaky wheel gets the grease." Staff knows which families are paying attention, so make sure that they know you.

UPDATE- I started to try and summarize and rank all of the nursing homes in the Guilford County and Greensboro areas. If you would like to see a ranking of best to worst of all homes, click on Guilford County Greensboro area nursing home review.