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Michael Hill | Oct 28, 2014

Measuring Nursing Home Quality Using Online Tools

Finding a nursing home can be a confusing, disheartening, and challenging process, especially when it is undertaken in short notice. Fortunately, there are more tools available than ever to find an appropriate long-term care facility for a loved one.

In principle, nursing homes serve society by providing appropriate care for persons who have chronic illnesses. In reality, however, nursing homes often fail miserably and in many cases place nursing home residents at risk of a serious injury.

Ohio’s Nursing Home Bill of Rights, R.C. 3721.13, http://codes.ohio.gov/orc/3721.13, provides an illustrative list of rights each nursing home is required to provide to its residents. Federal regulations require that nursing homes provide that level of care and those services necessary to attain or maintain each resident’s highest practicable physical, mental, and psycho-social well-being. 42 C.F.R. § 483.25. The nursing home must individually assess the needs of nursing home residents and develop a comprehensive care plan that includes measurable objectives and timetables to meet each resident’s medical, nursing, mental and psychosocial needs that are identified in the assessment. 42 C.F.R. § 483.20(b)(1)-(2); 42 C.F.R. § 483.20(d); 483.20 (K)(1). Once an appropriate plan has been developed, it must be implemented. Negligence often occurs when the resident is improperly assessed, when the care plan is never developed or ignored, or when there is no intervention following a change in the resident’s status.

While there are numerous federal and state laws and regulations that guarantee certain rights and care to patients, the typical recourse is through state law negligence claims after a loved one has been injured. It is important to find a long-term care facility that is appropriate for your loved ones before they are a victim.

ProPublica, the nonprofit investigative news organization, offers a tool called Nursing Home Inspect. http://projects.propublica.org/nursing-homes/. This tool allows users to compare nursing homes in a state based on the deficiencies cited by regulators and the penalties imposed in the past three years. You can also search over 60,000 nursing home inspection reports to look for trends or patterns.

In July 2012, the Centers for Medicare and Medicaid Services put the full text of the reports online that nursing home inspectors file for each facility. http://www.medicare.gov/nursinghomecompare/search.html. You can obtain the full findings by selecting “Inspections and Complaints,” then click on “View Full Report.”

Centers for Medicare and Medicaid Services’ Nursing Home Compare ranks nursing homes using star-rating system, with a one star rating being the lowest and a five star rating being the highest. While you would expect fewer stars to equal less satisfaction, a recent report out of Ohio says differently. On the one extreme, 20 percent of individuals and their family members provided high marks to the lowest performing nursing homes, those ranked with a single star. On the other extreme, forty percent of individuals and families gave very low marks to the highest performing nursing homes, those with rated as five star. See Paula Span, The Fault in Our Stars, The New York Times, July 8, 2014,http://newoldage.blogs.nytimes.com/2014/07/08/the-fault-in-ourstars/?_php=true&_type=blogs&_r=0. The study concluded that there was little difference in satisfaction between stars, i.e., between one and two stars and between two and three stars. One potential explanation for this discrepancy is that Centers for Medicare and Medicaid Services frequently measures objective items that are less important to residents, like measures of cleanliness and the number of staff, than more important but subjective measures, like resident satisfaction and consumer opinions concerning how they are treated by staff. As one commenter explained the problem with Centers for Medicare and Medicaid Services’ star rating approach, “It’s like publishing a Michelin guide that rates how clean a restaurant’s kitchen is and calculates whether there are enough waiters, but pays no attention to how good the food it.” Id. at 3.

Another tool for locating a long-term care facility is the Nursing Home Checklist, available at http://www.medicare.gov/files/nursing-home-checklist.pdf on the Centers for Medicare & Medicaid Services website. Centers for Medicare and Medicaid recommends that you take a copy of the checklist with you when you visit a nursing home to determine whether it is an appropriate fit for your loved one.

While no tool is perfect, there are more tools available than ever to locate an appropriate nursing home.