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By Pamela D. Wilson, CSA, MS, BS/BA, CG, The Care Navigator
The news recently buzzed about the Five Star Quality Ratings published for skilled nursing facilities. I was excited myself until I looked further into how the ratings were actually calculated. The ratings are based on three categories of data: health inspections, staffing and quality measures. (To read the explanation regarding determination of quality ratings visit http://www4.medicare.gov/NHCompare/static/tabhelp.asp?language=English&activeTab=6&subTab=0version=default).
The category entitled "Health Inspections" is the ONLY category that provides information derived from trained teams of surveyors. However the category descriptor also mentions that there are "differences in state licensing requirements that affect quality, and in state Medicaid programs that pay for much of the care in nursing homes." Additionally, "inspections don't identify nursing homes that give outstanding care. While reading these reports, keep in mind that the quality of a nursing home may get much better or much worse in a short period of time. These changes can occur when a nursing home's administrator or ownership changes or when a nursing home's finances suddenly change." I've personally experienced this myself when I've had clients in certain facilities, many of whom I would have previously recommended but would now not place my worst enemy.
The second category "Staffing", was based on "the overall number of staff compared to the number of residents and how many of the staff are trained nurses". This number was "self-reported" meaning that the rating relies on the integrity of the nursing home providing the information. Research shows that relying on numbers only is not a realistic measure of quality. After all how many times have we heard the joke "how many xyz does it take to change a light bulb"? (Visit http://www.adogslife.com.au/joke.htm to learn the answer). More relevant, an article in The Gerontologist related staffing levels and nursing home quality by focusing on staff stability, stating that "highly stable employees are likely to deliver consistent care and have a greater appreciation for care practices." Staffing quality is not only a numbers game.
Even more interesting is the category entitled "Quality Measures" which reports how well each nursing home performs on ten aspects of care such as dressing eating and preventing skin ulcers. These quality measures again are "self-reported" by each nursing home.
Let me play devil's advocate. Thirty three percent of the star rating is provided by a trained team of surveyors and the remaining 66% self reported. I would say that the ratings are more questionable than not especially taking into consideration that the surveys are done during a "snapshot" of time when many nursing homes are on their best behavior and the survey itself mentions quality can change at the drop of a hat. These 5 star quality ratings are no more reliable than 5 star quality ratings for restaurants. The rating all depends on the timing of the experience and the stability of staff providing the service.
So how does one determine what makes a good nursing home? It's not easy, especially if you're a family member trying to make a choice and are held captive by an insurance company that dictates which nursing homes are covered by your insurance. When in doubt, seek expert advice.
1) Castle, Nicholas G et. al. "Further Examination of the Influence of Caregiver Staffing Levels on Nursing Home Quality," Vol. 48, No. 4, 464-476.
Copyright © 2009 Pamela D. Wilson All rights reserved. This publication may not be reproduced by any mechanical, photographic or electronic process, transmitted or otherwise copied for public or private use without prior written permission from the author. Website: www.thecarenavigator.com
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