One in seven Americans age 65 and older will spend time in one of the nation’s 16,000 nursing homes this year, and for those 85 and older the chances are more than one in five. That adds up to about 3.3 million Americans.
To help patients and their families choose a nursing home and compare between different types of homes, the federal government hosts a web site called “Nursing Home Compare”.
In December of 2008 Centers for Medicare and Medicaid Services (CMS) enhanced the usability of its web site by adding an easy to understand five-star rating system. Each nursing home receives one to five stars based on performance in each of three key quality domains: Health inspections, reported staffing levels, and quality measures derived from mandated assessments of resident health and well-being. The data to allow for such ratings is taken from reports that must be filed by the skilled nursing facility to retain Medicare eligibility. In July of this year the Nursing Home Compare site added new options, allowing visitors to the site to see specific findings from nursing home inspections and providing easier navigation tools to allow comparison of such items as inspection deficiencies with the state average.
There does seem to be a bit of a disconnect between the star rating and consumer satisfaction. Some studies have shown that one-star facilities often rate higher in consumer satisfaction than five-star facilities, something that one would not expect. Also, sometimes a facility will have low marks in each of the first three categories and then, for reasons unexplained, will have a five-star or four-star overall rating. For example, a local facility here in Humboldt County has one star for health inspections, two for staffing levels, and three for quality measures, yet, somehow, manages to be rated four stars overall.
Also, staffing, which is one of the bases for the CMS rating system, is “self-reported” and thus a facility may provide incorrect information to CMS to make itself look better. Staffing data is reported just once a year and reflects staffing over a two-week period only. Thus, to achieve a higher rating, a facility can “staff up” during that two-week period in order to increase its star rating.
Ultimately, then, while Nursing Home Compare and its “star” system are a good place to start, the consumer should also visit the site of a potential care home to see the level of care. The best time to do a site visit is early on a Sunday morning or the day after payday. If a facility is going to be understaffed, those are the usual times that it occurs, and an inspection at that point would be every helpful to determine whether or not your parent or loved one will receive adequate care. Also, if possible, stay close to home when selecting a facility so that it can be easily visited. The more a family can visit, the better the care will be.