When it comes time to place a loved one in a nursing
home, or to select a facility for their own care, many Americans find
themselves in unfamiliar territory.
A new Commonwealth Fund–supported nursing home guide
published in the September issue of Consumer Reports is likely to
make this process less stressful—by identifying the highest- and
lowest-performing nursing homes in each state and offering tips on how
consumers can evaluate the homes that fall in the middle. The
investigative report, "Nursing
Homes: Business As Usual," written by Trudy Lieberman, director
of the Center for Consumer Health Choices, also serves as a wake-up call
for the 12
nursing homes in the nation that have been cited for poor care by Consumer
Reports for five years in a row, as well as for the state agencies
responsible for monitoring quality of care in these facilities.
How to Choose a Good Home
For its report, Consumer Reports analyzed the three most recent
state inspection reports for the 16,000 nursing homes across the U.S. and
examined staffing levels and quality indicators, such as how many
residents develop pressure sores when they have no risk factors for them;
the proportion of residents who spent most of their time in bed; and the
proportion of residents who experienced a decline in their ability to move
Home Quality Monitor, available online as a clickable state map, is a
database of homes to consider—and homes to avoid—in each state. The
monitor also indicates if a home is for-profit, non-profit, or
government-owned, and whether it's part of a chain or independently owned.
These are key facts to know, as the Consumer Reports analysis
found that non-profit homes are more likely to provide good care than
for-profits. Researchers also learned that independently run homes are
more likely to provide good care than chains.
Other recommendations for individuals or families
searching for a nursing home include:
Visit the homes. Once you've
selected a few homes, make unannounced visits at different times of
Read each home's state inspection survey.
This report, called Form 2567, should be accessible to all visitors.
Difficulty obtaining the report may suggest the home is trying to
cover up negative information. A long report often indicates a
facility has many deficiencies.
Ask about top-level turnover.
Frequent changes in the administrator and the director of nursing
positions could be an indication of poor care.
Why Hasn't the Industry Improved?
The number of poorly performing homes Consumer Reports uncovered
shows that bad care is still a problem in this country, despite the
passage of a 1987 federal law designed to improve nursing home care for
the elderly. The report suggests that enforcement may be part of the
problem. According to the Centers for Medicare and Medicaid Services,
deficiency citations written by inspectors today are less likely to
contain codes that indicate severe problems than they were in 2003.
Additionally, the report points out that state agencies
have been slow to impose or collect fines from poorly performing homes.
For example, eight of the 12 five-time repeaters on this year's list of
poorly performing homes were not fined by the state between 1999 and 2004.
Moving Toward Resident-Centered Care
So how can we get the nursing home industry at large to buy into
high-quality care that prioritizes the needs of residents? It's clear that
legislation and regulations alone will not drive the change toward
resident-centered care. Consumers must push industry to provide the kind
's elders deserve.
The Picker/Commonwealth Quality of Care for Frail
Elders program supports the development and spread of culture change in
nursing homes by helping to form and test models, such as nonprofit
nursing home collaborative Wellspring
Innovative Solutions for Integrated Health Care, the Mississippi-based
Green House Project, and the Meadowlark
Hills retirement community in Manhattan, Kansas. The Frail Elders
program also fosters leadership organizations, such as The
Pioneer Network, and supports resident-centered care policy
The program has also identified projects that empower
consumers. The recently released book, 20
Common Nursing Home Problems and How to Solve Them, by Fund
grantee Eric Carlson of the National Senior Citizen's Law Center, was
highlighted in a Wall Street Journal article and has become an
important resource for state and local long-term care ombudsman, who
assist nursing home residents and their families.
By becoming consumer-savvy and demanding good,
resident-centered care, nursing home residents and their families will
help create demand for facilities that not only properly care for
residents, but also make them as comfortable and independent as possible.
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