Special to Tribune Newspapers
September 22, 2009
Ideally, consumers would have a wealth of data and reports and clear-eyed assessments of nursing home quality. As of now, that's not the case.
Although the Centers for Medicare and Medicaid Services created a website called Nursing Home Compare in 1998 -- providing information on nursing homes certified by Medicare and Medicaid including ownership of the home and characteristics of its residents, staffing and quality -- the site's usefulness has been criticized since its inception.
Legislation being considered as part of healthcare reform bills in the House and Senate would make the site more accurate and comprehensive.
That legislation, the Nursing Home Transparency and Improvement Act, would require the site to provide more precise data on staffing ratios and facility ownership, and improve and accelerate the complaint process. It would also require the Department of Health and Human Services to scrutinize the site to ensure the information provided is clear to consumers.
"I think all of us would turn there [to the site] first, even though we are skeptical of it," says Janet Wells, policy director for the National Citizen's Coalition for Nursing Home Reform, which provides advocacy, education and policy analysis on nursing home reform issues. "My concern is that people don't understand you can't just pick the best rating and assume that it will give an idea of what the care of a facility is like."
Currently, the site lists only complaints that are substantiated, which is a problem, says Pat McGinnis, executive director of California Advocates for Nursing Home Reform. McGinnis estimates that a mere 25% of complaints are substantiated because backlogs at health departments delay investigations until witnesses are gone or residents have died. She also questions the staffing ratios listed -- a major indicator of quality -- because they are self-reported.
Further, the site's quality measures are skewed, she says. Because homes are rated on the number of patients who need acute care, facilities providing care for a high number of such patients are generally rated lower than others.
"Nursing Home Compare makes some of the worst facilities look like some of the best and vice versa," McGinnis says.
A spokeswoman for the Centers for Medicare and Medicaid Services acknowledged the limitations of the site. "It's frustrating sometimes because things happen that are difficult to document because the nursing staff is not likely to report mistakes they made," says Mary Kahn, a CMS spokeswoman.But she adds: "Nursing Home Compare is not the only tool for families to use -- it is not intended to be that, and is impossible for it to be that."
Get a Full Picture
That's not to say consumers can't make better-informed choices. Kahn recommends that families use the site by printing out a facility's inspection, taking it to the facility and reviewing it with the staff to see what kind of improvements are being made.
The site's current assets, Kahn says, include a three-year listing of health inspection results and a comparison of how facilities compare statewide and nationally on 19 quality measures. It also lists homes that are part of a special focus facility project; those that are the poorest performers and thus receive technical assistance from the Centers for Medicare and Medicaid Services are marked with an icon denoting them as such.
Each state also has an ombudsman program through its department of health, which tracks complaints and issues in the homes. Ombudsmen are often willing to speak frankly about area facilities, says Larry Minnix, chief executive of the American Assn. of Homes and Services for the Aging, a nonprofit organization that represents not-for-profit elder care facilities.
Families can also find information on the most recent state survey of a facility (Form 2567) posted in a public area at the nursing home. It will have information on deficiencies and citations found during the most recent state inspection. Inspections should be held by the state every 12 to 15 months on behalf of CMS.
Complaints filed against a facility are also important indicators of the quality of a facility, McGinnis adds. Substantiated complaints can be found at each state Department of Health. McGinnis says it is important to consider complaints because they are difficult to file, particularly by residents and families who are often afraid of recourse.
But maybe one of the most important ways to ascertain whether a facility will be a good fit for a family member is to discuss it with him or her.
"If you can, you ought to have a conversation among family members and ask them which ones (facilities) they would want the family to explore," Minnix says. "If they don't want to talk about it, tell them you just want to know their wishes."