The Centers for Medicare and Medicaid Services has just published an new rating system for nursing homes that they hope will make choosing a facility simpler and easier to understand. The system consist of awarding stars based on several criteria such as staff turnover, patient care, the number of patients with urinary infections and performance in recent health inspections. The homes are given from one to five stars.
The report also published that some states have very few nursing homes that are up to standard. Far too many had only one star and the number of five star facilities in the states mentioned was very low. More than 15,500 homes were rated and the overall breakdown was
Five star homes 1,893
Four star homes 3,640
Three star homes 3,302
Two star homes3,204
One star homes3,545
There is no doubt that many nursing homes need to improve their patient care, and it is also true that this system could prove to be more effective in forcing needed changes than the systems used in the past.
It must be said, however, that it is almost impossible to judge any nursing home by a set of criteria created by a government agency and presented as a one size fits all program. There are so many variables involved. An example of that is that the states the report used as bad examples are the poorer states who must offer care to more people who cannot afford it than the state of Delaware which had the highest percentage of five star homes. If these variables are not included then those states will always be rated as low quality care states.
This is not a defense of nursing homes. My work has allowed me to be in hundreds of them in every state and even some other countries. I have seen first hand the need for reform and, in some cases, almost criminal neglect.
I have heard enough horror stories to make a movie, but I have also heard glowing reports of wonderful care and happy families. The question then becomes how does someone find a good nursing home?
USE THE NEW CRITERIA, BUT GO BEYOND IT. Even the agency that formed the new regulations say that the ratings do not take the place of a family visiting a facility for themselves. The ratings are a good place to start. If there is a five star home in your area, it would only be logical that you would go there first. But, don't be surprised if you find a home with less stars that fits you and your loved one better. Look at the stars with an open mind.
INSPECT FOR YOURSELF. Visit the home several times. Do so without warning them that you are coming, but don't go in like a mother-in-law looking for dust. Go in looking for the spirit of the place. Watch the interaction between the staff and the residents. I have been in beautiful homes I would never want a loved one of mine to live in, and I have been in some rather shabby looking ones that I would choose in a moment. Happy employees bantering with residents and each other is more important to me than how beautiful the drapes happen to be.
I walked through one nursing home that really needed an upgrade. It looked worn and faded, but the administrator lead me on the tour and it seemed to take forever. She had to stop and hug every resident she met and it was evident this was not a one time show. She knew them all and their faces lit up when she appeared. I would chose her over any star rating system that could ever be invented.
Every home will smell sometimes. They should not smell every time of course, but aged people live there and sometimes we wet our pants. Every nursing home will have some urinary infections, that’s what happens to us when we get old. They certainly should be able to show intense efforts to cure them, but they will be there. Every nursing home will be in a constant fight with bed sores. Our skin gets thin and brittle with age and we loose all of our padding so, when we are confined to bed, we face this problem. These certainly should be the exception and should be constantly monitored, but bed sores are going to happen even in five star homes or five star hotels as well.
The rating system is a welcomed help for families needing long term nursing care, but no one should ever make the choice based just on how many stars some far off judge decided to give based on some statistics. Statistics can't feel the spirit of the place.