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Government Launches Nursing Home Rating System
Date:12/18/2008

Five-star rankings aim to help families choose best option

THURSDAY, Dec. 18 (HealthDay News) -- The Centers for Medicare and Medicaid Services unveiled an updated Web site Thursday intended to make choosing a nursing home easier for elderly Americans and their families.

The updated Nursing Home Compare site uses a five-star rating system, similar to that used for hotels and motels, to rank institutions nationwide.

"The old site had a lot of information, but the information wasn't necessarily terribly usable by the average consumer. You knew if the facility was above or below the state average, but you didn't know what that meant," said Charles Phillips, a professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health, in College Station. "What you have with the five-star system is a very well-thought-out way of summarizing all of that information that was available on the earlier site with new information. … This allows you to do a much more direct comparison in a user-friendly way."

Roughly 10 percent of the facilities have five stars and roughly 20 percent have one star, said Phillips, who served on the advisory panel that developed the rating system.

Geriatric experts, however, were concerned the site might not reflect patients' and families' true concerns.

"My reaction [to the site] is I have never been asked any of these questions because people assume good medical care, maybe incorrectly," said Debra Greenberg, a senior social worker in the division of geriatrics instruction at Montefiore Medical Center and Albert Einstein College of Medicine in New York City. "There are other quality-of-life issues they are very concerned about -- the atmosphere, cleanliness, ratio of nursing professionals, the ability to go visit. None of that is reflected in what gives this a five-star rating."

Dr. Laurie Jacobs, director of the Resnick Gerontology Center, also at Montefiore Medical Center and Albert Einstein College of Medicine, said that "the positive about this is they are finally bringing to the public a rating of medical care that had been a mystery before, based on surveys, but it's limited to that and has none of the other information that families also desperately want when they want to decide on a facility."

Meanwhile, the National Citizens' Coalition for Nursing Home Reform issued a statement saying it is "fully aware of the shortcomings of the rating system," but it would still support it as an important educational tool.

But the American Association of Homes and Services for the Aging was more critical of the new effort.

"The five-star rating system is a great idea prematurely implemented. We support a consumer-friendly nursing home rating system based on reliable quality information that the public can understand. But what is being launched tomorrow is poorly planned, prematurely implemented and ham-handedly rolled out," Larry Minnix, president and CEO of the association, said in a statement.

The importance of comprehensive, up-to-date information on the nation's 16,000 nursing homes is indisputable.

U.S. Census figures project that the number of Americans age 65 or older will double by 2030 and that two-thirds of today's 65-year-olds will require some period of long-term care later in their lives.

According to the Centers for Medicare and Medicaid Services (CMS), more than 1 million Americans enter a nursing home each year.

The decision to enter a nursing home -- or to place a family member in a nursing home -- can be gut-wrenching.

"This is one of the hardest decisions that families ever make," Greenberg said.

Rankings on the new site are based on input from three areas: quality measures, nurse staffing levels and health inspection reports.

"You get stars for the overall status of the facility, but you also get information on how many stars they got on staffing and how many on the quality measures," Phillips explained.

Although the Web site formally launched Thursday, CMS is soliciting comments on the site through June and July.

But Nursing Home Compare online should not be the only source families use, experts noted.

"Things like Nursing Home Compare are tools, not the be-all and end-all," Phillips said. "Any individual who faces putting someone in a nursing home should talk to the nursing home ombudsman in the area. They're at the area agency on aging."

"The other thing is, there is absolutely no substitute for physically going to the facility yourself and getting a picture of what that facility is like and whether or not you think your loved one will be comfortable in it," Phillips added.

Data are also available from the United Jewish Federation, which has regional offices, as well as from the U.S. Department of Aging and from Friends and Relatives of Institutionalized Aged, Greenberg added.

More information

Check out the updated nursing home Web site.



SOURCES: Charles Phillips, Ph.D., Regents professor, health policy and management, Texas A&M Health Science Center School of Rural Public Health, College Station, Texas; Debra Greenberg, M.S.W., Ph.D., senior social worker, division of geriatrics instruction, Montefiore Medical Center and Albert Einstein College of Medicine, New York City; Laurie G. Jacobs, M.D., director, Resnick Gerontology Center, Montefiore Medical Center and Albert Einstein College of Medicine, New York City; Dec. 17, 2008, statement, National Citizens' Coalition for Nursing Home Reform; Dec. 17, 2008, statement, American Association of Homes and Services for the Aging


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