Are good nursing homes hard to find

Aging, Spring, 1996

Nursing homes, traditionally the province of mission-oriented religious groups, have increasingly become for-profit businesses. Nearly 70% of all nursing homes in the U.S. are now investor-owned. Unfortunately, many of these facilities are providing substandard, even poor quality, care, according to Consumer Reports magazine in its August 1995 issue ("When a Loved One Needs Care").

The article is based on a year-long investigation into the long-term care system, during which a senior editor, posing as a daughter whose mother needed care, visited 53 nursing homes and 27 assisted-living facilities, requested assistance from government and other referral agencies, and analyzed thousands of inspection reports from the Health Care Financing Administration (the agency that certifies most nursing homes receiving payment from Medicare or Medicaid).

Consumer Reports maintains that Federal and state governments, through Medicare and Medicaid, are currently paying 60% of nursing home costs without demanding very much in terms of quality. For example, about 40% of all Medicare-certified facilities have violated Federal standards covering critical aspects of patient care in the last four years. Many of these facilities failed to produce required care plans to assure decent quality of life, improperly used physical restraints, or failed to meet basic standards for sanitary food preparation. Moreover, some nursing homes refused to make their inspection reports available to consumers seeking information on quality of care. This leaves consumers pretty much on their own in trying to locate reputable facilities and the appropriate care level to meet their family member's needs.

To aid families in their search, Consumer Reports used data from four years of nursing home inspection reports to compile ratings on 43 for-profit chains and nonprofit religious groups that operate about 4,000 nursing homes across the country. The three top-rated groups are nonprofit and affiliated with the Friends General Conference, Church of the Brethren, and the Episcopal Church. However, the top third of the ratings included roughly equal representation of for-profit chains and nonprofit groups.

For families wanting information based on direct experience with different nursing homes, Consumer Reports staff found that the best advice may come from the state or county ombudsmen who are charged with monitoring local long-term care facilities, resolving complaints, and advocating for resident interests. But even ombudsmen may not be forthcoming about the deficiencies of facilities, the magazine says.

To guide families in locating a suitable nursing home, Consumer Reports also suggests the following steps:

* Obtain a list of facilities in your area from your local AAA or department of elder affairs. You can find the agency nearest you through the Eldercare Locator or the Yellow Pages.

* Contact your state or county ombudsman for information on specific facilities. (See the list of state ombudsman offices on page 114.) While they may not tell you everything they know about poor quality care, they may tell you which homes they consider particularly good. Remarks such as "Yoia may want to look further," may be guarded tip-offs on poor quality care.

* Try to obtain state inspection reports on a facility. These reports detail any violations and provide information on how the facility treats its residents.

* Tour the facility on your own. Visit, unannounced, at different times of the day or week. Be alert to signs of gross neglect, such as odors, safety hazards, unkempt patients. Stroll through the corridors. Talk with residents and staff.

* Visit at mealtime. Notice whether staff is available to help residents who can't feed themselves.

* Look for activities that foster socialization.

* If you see residents in restraints, ask whether there is a medical order for them from a physician.

* Once your relative is placed in a nursing home, stay involved. Make sure there is a care plan and attend care conferences. Don't hesitate to use the ombudsman if you have trouble resolving complaints.

"When a Loved One Needs Care" is the first article in a 3-part series on long-term care. The second article, "Who Pays for Nursing Homes?" (Consumer Reports, September 1995) examines public policy on the financing of nursing homes and offers suggestions for families facing the cost of long-term care. The third article, "Nursing Homes: What are the Alternatives," (Consumer Reports, October 1995) looks at home care and assisted living facilities. Reprints of these reports are available from Consumers Union/Reprints, 101 Truman Avenue, Yonkers, NY 10703-1057; call (914) 378-2000 for pricing and information.