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Nursing Homes: Finding the Good, Avoiding the Bad

Despite federal regulations designed to improve nursing homes, the state agencies responsible for overseeing nursing home care have often failed to correct problems, according to a Commonwealth Fund–supported study in the September issue of Consumer Reports.

For her investigative piece, "Nursing Homes: Business as Usual," journalist Trudy Lieberman analyzed state inspection reports for 16,000 U.S. nursing homes, as well as staffing levels and quality indicators, such as the number of residents who develop pressure sores despite the absence of risk factors. The state-by-state Consumer Reports Nursing Home Quality Monitor database names facilities in each state that rank in the best or worst 10 percent on at least two of three dimensions of quality.

Lieberman, who directs the Center for Consumer Health Choices, said the findings serve as a wake-up call for the 12 nursing homes in the nation that have been cited for poor care by Consumer Reports for five years in a row, as well as for the state agencies responsible for monitoring quality of care in these facilities.

The Nursing Home Quality Monitor, available online as a clickable state map, is a database of homes to consider—and homes to avoid—in each state. The monitor also indicates if a home is for-profit, non-profit, or government-owned, and whether it is part of a chain or independently owned. According to the researchers, people can increase their odds of choosing a good nursing home if they narrow their search by type. For example, not-for-profit and independently run homes are more likely to provide good care than for-profit or chain facilities.

The article also cautions those searching for a nursing home not to depend on the federal Nursing Home Compare Web site, which can provide an incomplete and sometimes misleading picture of individual homes. Consumers should also make unannounced visits, at different times of the day, to the facilities they are considering. Finally, read each home's Form 2567—the state inspection survey—which is supposed to be readily accessible by law. If it's not, and you have difficulty obtaining a copy, consider that as a warning that the facility may be hiding damaging information.

In her essay "Nursing Homes 101," Fund Assistant Vice President Mary Jane Koren, M.D., who heads the Picker/Commonwealth Quality of Care for Frail Elders program, argues that consumers must be the ones to push the nursing home industry to reach higher standards of care. "By becoming consumer-savvy and demanding good, resident-centered care," Koren says, "nursing home residents and their families will help create demand for facilities that not only properly care for residents, but also make them as comfortable and independent as possible."

The Fund's Frail Elders program has identified projects that empower consumers. For example, the recently released book, 20 Common Nursing Home Problems and How to Resolve Them, by Fund grantee Eric Carlson of the National Senior Citizen's Law Center, has become an important resource for state and local long-term care ombudsmen, who assist nursing home residents and their families.

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