It's a search no one undertakes lightly, or happily. Finding a nursing home for a parent or loved one, a place where they will live for months or years and almost certainly spend their final days, is a stressful, high-pressure task. Entrusting a family member, at their most vulnerable, to the care of strangers is a huge leap for any adult child.
New websites aiming to facilitate the search make the task somewhat easier. The most notable: Nursing Home Inspect, launched by the nonprofit news organization ProPublica. It's the first resource that allows consumers to search current Medicare inspections of nursing homes to identify deficiencies and complaints. The site draws its data from the same set of Medicare inspection reports as the recently redesigned federal website Nursing Home Compare. ProPublica says visitors can find almost 118,000 cited deficiencies among more than 14,000 facilities nationwide in its constantly updated database.
What Does the Data Tell You?
That's a lot of data. But is it useful? A visitor to Nursing Home Inspect can search by keywords — such as injury, ignore, abuse and bed sore — and read full reports on complaints against local facilities. But those search results can be deceiving. Inspectors in different areas may have different standards for terming an incident a deficiency. One may cite any instance of a resident leaving the building without supervision to be what the industry calls an "elopement," even if the resident takes only a few steps onto the front lawn and returns. Another inspector may cite a facility for elopements only when a resident leaves the grounds altogether and must be tracked down. Similarly, "abuse" may refer to a range of concerns, from physical assault to the theft of a sock, depending on how a report is written. Reading full reports helps, but they can be lengthy and bogged down in administrative terminology, and many details are redacted to protect the privacy of residents.
The deficiencies listed on Nursing Home Inspect are rated from A through L, the latter being the most severe. These grades take into account both the severity of deficiencies and how widespread they are. "A 'D' may or may not be OK depending on whether it was an isolated incident or affects a broad swath of people within a nursing home,” says Tom Burke, spokesman for the American Health Care Association, an industry group representing more than 11,000 non-profit and for-profit nursing facilities and other care providers. “It’s complicated — and that’s part of the problem.”
ProPublica is aware of these limitations and provides a detailed tip sheet to guide visitors' searches. It also tries to offer some perspective. For example, the federal Government Accountability Office found that of nearly 50,000 nursing home complaints investigated in 2009, about 1 in 5 resulted in at least one citation. (That figure, however, ranged from 30 percent in some states to 10 percent in others.)
So, at minimum, the site's information should be taken with a grain of salt. But its results can be a valuable piece of a family's search for a facility. “Any online tool is one information point, but it should not be the sole information point in choosing a nursing home," says Lauren Shaham, vice president of communications for Leading Age, an international network of aging services organizations. "Nursing Home Compare and Nursing Home Inspect are conversation starters for when you visit a nursing home and talk to the staff, talk to residents and ask questions about what you’ve seen in the data."
Passing the Smell (and Taste) Test
Nursing home administrators are well aware of deficiencies listed in their reports and should be prepared to address them with visitors. "Any good nursing home should be more than willing to have that conversation," Shaham says. "If they’re not, that’s a point of concern because transparency is very important in ongoing care."
Talking with administrators who are willing to be frank about past problems and the steps taken to correct them can be productive. "The data in the reports represent a snapshot of a certain time and there’s somewhat of a lag between the data posted and the current time," Shaham says. "It could be that things have changed between when the data was reported and what the situation is at the nursing home right now.”
Burke agrees. “A facility might get dinged for something legitimate and bad, but the fact is that bad things happen in good facilities," he says. "What matters is what they do to correct those situations.”
But fundamentally, inspection reports are intended only to locate deficiencies in nursing homes, not to identify or praise successful programs or conscientious staffers. "Inspection reports don’t present a full picture of whether a nursing home is offering quality," Shaham says. "The best indicators are recommendations from others and the 'five senses test' when you go to a nursing home and see it, smell it and taste the food."
Why Word of Mouth Is Still Crucial
Adult children living far from their parents face particular challenges in choosing a facility. Burke recommends starting with calls to a parent’s doctors, nurses, friends or clergy — “people who know the area” — to get the names of local residences that are reputable and meet a family's criteria. "Word of mouth is so important," Burke says. “At some point, you have to talk to somebody about what that facility is really like."
Nursing Home Compare provides some help in narrowing a search, Burke says, as the site grades most nursing homes on a Five Star Quality Rating System, based on its inspection reports. It's a feature that's controversial among many providers, he says, "but the fact is, there’s often a clear difference between a five-star and a one-star facility. So from purely a 90,000-foot level, five stars is a good starting point for consumers. The problem is, most facilities fall in the vicinity of two, three or four stars.”
Seeking a nursing home for a loved one makes many people uncomfortable, so they put it off until it's too late. Even if you're not currently looking for a facility, it's wise to start your research now if you think there's a chance you'll need to find one in the next few years. “We urge consumers to know about the nursing homes in their community that they think they would prefer well before they need one," Shaham says. "Most people wind up in nursing homes after being discharged from a hospital and there’s not a lot of time then to visit, do research or talk to the staff.
“If you’re aware of the quality offerings in your community when you don’t need them, you’ll be ready when you do.”