elder-helper

The truth behind the Nursing Home Compare website

Let's just say the long term care industry was not real thrilled when they first heard about a "5 star rating system" being purposed
by the federal government to make public a nursing home report card. It sounded like a nightmare scenario. A nursing home's
'dirty laundry' will be made public for not only perspective customers to see but also your competition? Yikes! This is horrible. I
must say that in some ways I kinda agree.

The Nursing Home Compare 5 star rating system is based on state survey inspection results; the number of staff and
specifically, RN hours; the clinical report card known as the Quality Measures report and the fire safety inspection report. This
report only applies to nursing homes that receive Medicare and Medicaid funding. Below are some reasons that the nursing
home compare website may not be as useful as you might think.

1. Even if a nursing home cleans up it's act and clears any deficiencies with the state inspectors, the Nursing Home Compare
website is not current. It displays rather old information which can result in an unfairly low rating.

2. The Quality Measures rating can easily be manipulated by unscrupulous facilities. I won't go into details but if a facility wanted
to, they could instruct their staff to code certain assessments that impact the Quality Measures report for gain i.e. don't code
things that will make us look bad. This in turn would boost the 5 star rating. I personally know of some 'for-profit' facilities that
hire lawyers and physician consultants to argue with state inspectors over coding. They will fight tooth and nail to avoid coding
anything that puts their facility in a bad light. This artificially inflates their 5 star rating which defeats the purpose of the Nursing
Home Compare service in the first place.

3. If a facility has high staff turn over and the people hired to code the assessments that trigger the Quality Measures report are
doing a poor job and coding inaccurately, this can artificially lower the 5 star rating.

4. Every facility struggles with staffing at one time or another. The fact is, very few Registered Nurses are needed in long term
care. A facility needs a few but they can provide high quality care with a large number of Licensed Practical Nurses. To punish a
facility with a lower rating based on the number of Registered Nurses working at the facility seems unfair, especially when there
is currently a national nursing shortage that affects all areas of health care from hospitals to nursing homes.

5. The fire safety inspection report can be deceiving. The local fire marshal performs the inspection annually and unfortunately, it
can be subjective. There can be a new fire marshal every year depending on the local election process. Each fire marshal sees
things differently. One may see no violations while another a year later will inspect the exact same facility in the exact same
condition and site the facility with safety hazards.

In my opinion, don't be turned off to a facility just because it received only 2 or 3 stars out of 5. To really know if the facility is a
place that you would want a loved one to receive care, you need to tour the facility in person. Ask to see the most 'current' state
survey results (they are required to have a copy handy), ask if they are currently in 'substantial compliance' and if not, what do
they plan to do about it and when? Ask them if they are aware of their 5 star rating and do they feel it accurately reflects their
performance? Your gut instinct and what you witness during a tour are your most valuable tools.