To help you understand the information we have listed some examples that could help to explain facility ratings. By reviewing the examples provided, it may improve your understanding of how facilities are reviewed.

• You might find a higher incidence of patients with pressure sores in a facility that specializes in the treatment of them.
  
• You might find a higher number of non-ambulatory patients in a facility that specializes in rehabilitation therapies.
  
• You might find the quality measure for pain higher than the state average due to a high rehabilitation population who cannot take excessive pain medication in order to participate in rehabilitation therapies.
  
• You might see a high score on the incidence of pain in a facility which may indicate that the facility has in place an aggressive pain management program. In such a facility, patients are frequently asked about pain, the responses are recorded, and the patients' pain addressed.
  
• You might see a high incidence of incontinence in a facility and you need to understand that as residents age, their bowel and bladder function may decline, and it is the facility's responsibility to try to provide the necessary interventions to assist them with either re-training, setting schedules, or utilizing others means to manage the problem.
  
• You might find a high incidence of restraint use and you need to be aware that bedside rails are considered a restraint. Many families and residents request that side rails be used for their own emotional security and safety.
  
• You need to understand that facilities that care for patients with degenerative and progressive diseases will have a higher incidence of loss in function.
  
• You might see a high incidence of infections in facilities that are vigilant in identifying and treating infections.
  
• Moreover, you need to be made aware that facilities document and code the MDS according to all diagnoses whether the condition was acquired prior to admission or within the period of stay in the facility.

In seven of the measures, a higher score indicates the need to obtain further clarification. However, a high score in "patients who improve in walking," is a positive result. So again, having all the information to correctly interpret the data is essential.

Hawaii's dedicated caregivers work very hard to make our nursing homes quality facilities and genuinely wish to provide accurate and objective information to you, which is why everyone is so excited to participate in this initiative. We all look forward to further enhancing the quality improvement efforts our nursing homes already have in place.