Making a decision about a nursing home can be one of the most important choices a person is ever asked to make for a loved one. Unfortunately, these decisions often have to be made during a crisis period after a stroke or other illness has incapacitated a parent or spouse.
The federal government recently released a ranking nationwide of nursing homes that receive Medicare or Medicaid as part of an initiative to improve nursing home care in the U.S. The rankings can be a valuable tool, but it is important to understand the different categories that are being monitored. And the rankings shouldn’t be the only tool people use to make decisions about nursing homes.
“Unless you read the whole report, it is not particularly valuable,” says Jill Mack, administrator of Dunbar Village, Bay St. Louis. “If you read the whole report to see what the figures mean under each category, then it is definitely worthwhile. But I would hate to see someone just read the numbers without reading the backup data.”
There are six categories of data in the rankings, and each nursing home’s score is compared to the state and national average. The categories are pressure sores, infection rates, pain, percent of patients in restraints and patients’ ability to conduct daily living activities such as walking and eating without assistance. In the case of Dunbar Village, the nursing home scored lower on pressure sores (zero compared to an average of 8%) and lower on infection rates (zero compared to average of 13%). But the nursing home ranked higher on pain with a score of 16 compared to the average of 11%.
Dunbar’s higher score in pain means they are doing a better job checking patients for pain. With incapacitated patients, caregivers can’t always tell just by looking at them that they are in pain.
“Some people might be in pain and no one has bothered to check them,” Mack said. “Because we are careful to check if our residents are in pain, we are able to see if they are in pain even if they are not cognizant. With a higher percentage in this category, you may be a better facility. I give that as an example of why you need to read the background materials to understand what the rankings mean.”
As the report says, it is important to use the nursing home rankings as a starting point. The data alone should not be used to make a decision. But, Mack says, often people only look at the numbers.
“I really think the best thing anyone can do is visit a variety of nursing homes, if you are going to have to use one,” Mack said. “Don’t just talk to the administrator or the social worker. You need to tour the facility because the front office doesn’t necessarily show you what the resident area is like. For example, when people tour here they always remark, ‘This is amazing. There is no smell.’ It doesn’t have to smell bad in a nursing home, and it shouldn’t smell bad.”
Mack recommends coming at different times of the day while being aware that times such as immediately after lunch might be hectic because staff members are taking residents back to their rooms for a nap.
“You do have to take into account what is going on,” Mack said. “I think the attitude of the people is important, also. If you go into a facility where there are no smiles and everyone is whizzing around and uptight, you need to think twice about it. We are interested in people who love this kind of work and are happy doing it, and want to be part of a family of employees. We want our employees to really love elderly people and enjoy helping. And it shows because people are happy, and the staff interacts with the residents. You will constantly see staff members stopping and saying ‘hello,’ and asking how people are doing.”
Many people not familiar with nursing homes may have the impression that most of them provide substandard care. That may be because of ads by plaintiff attorneys seeking cases regarding nursing home abuse. Mack says generally nursing homes are a great deal better than the press they have gotten.
“I think there are a few bad apples in the industry, and it is a shame some lawsuit-happy attorney puts out ads on television and on billboards that make people think the entire industry is the pits,” Mack said. “It is just not true. The average nursing home is a good place, and some place you could feel comfortable leaving your loved ones. But since there are a few bad apples, that is why it is important to visit in person and tour the facility.”
Each state in the country has a state ombudsman who is an advocate for people who live in nursing homes and personal care homes. In Mississippi the ombudsman program is under the Mississippi Department of Human Services, Division of Aging and Adult Services. Anniece McLemore, state ombudsman, said her staff of 29 are advocates who visit nursing homes to receive, investigate and attempt to resolve complaints by or on behalf of residents. The ombudsman program is also charged with helping provide information to consumers on the current national nursing home quality initiative campaign.
“Our office has received quite a few telephone calls concerning the initiative, what it means, and how it is going to affect the quality of care in nursing homes,” McLemore said. “Our role is to help with consumer education and the quality improvement process. The whole goal of the initiative is to improve the quality of care of nursing homes throughout nursing homes in Mississippi and the country.”
The report ranking nursing homes covers 17,000 nationwide, which represents a huge amount of data. The report has been criticized for a number of errors. For example, in the Mississippi portion of the Web site, a key telephone number is wrong. The federal General Accounting Office said the study data was released prematurely, and a consultant hired by the government concluded that up to 40% of data regarding several conditions, including pain, was flawed.
McLemore said the new nursing home rankings can be useful, but shouldn’t be used alone. Her office advises people who are looking for nursing home care to talk to people who live in them.
“The nursing home quality initiative is very much needed,” McLemore said. “But it is not the only source of information out there. There are other sources that are just as important, such as visiting the home. No matter how much written information people give you, you have to walk into a facility to be able to see if people are satisfied and happy. You can talk to other family members. Observe whether, in your estimation, there is enough staff. Are residents’ needs being met or attended to? It is very helpful to go into the facilities, and go at times they aren’t expecting you.
“And call us because we are a good source of information because we go in there every day. In fact, the ombudsman program is the only outside government source that goes into nursing homes regularly. We advise consumers, family members and residents on how to handle problems. We investigate their complaints, and then we help with referrals to another government agency if necessary.”
If possible, take the person who is going to be living there on a tour of the nursing home. Make sure the home is well lighted because many elderly people have vision problems. And check out the meals. Is the food appetizing? Is someone helping residents eat if they are too frail?
Someone investigating a nursing home can also get a checklist from the ombudsman’s office. This office doesn’t have regulatory or legal authority. If an issue can’t be resolved, referrals can be made to the State Department of Health on issues of cleanliness and sanitation, and in the case of alleged abuse, neglect or exploitation, referrals are made to the State Attorney General’s office.
formation on the ombudsman program, call (601) 359-4927. The nursing home rankings are available at the Web site http://www.medic