Editorial: Don't stop at the stars

Sunday, January 04, 2009 3:00 AM  |  Printer friendly version | E-mail to a friend | Anyone who's ever had to select a nursing home for a spouse, a parent, a child or perhaps even for one's self knows it can be a stressful, exhausting and frustrating process.

A new rating system for nursing homes, unveiled last week by the federal Centers for Medicare & Medicaid, should make navigating the system somewhat easier. The rating system, which has been criticized by some nursing home groups and praised by some consumer advocates, shouldn't be considered the final arbiter of which homes are good or bad. Instead, think of it as a useful starting point for research — one that needs to be supplemented by first-hand visits to facilities, interviews with staff and, ideally, recommendations from those who've had firsthand experience with a particular home.

As a starting point, the rating system has the virtue of being easy to navigate and simple to understand. Go to the Medicare & Medicaid Services Web site (www.medicare.gov/NHcompare/), plug in a particular area by zip code (or a nursing home name) and you can instantly see how a nursing home scores in specific areas. The rating system awards one to five stars in separate categories for quality, staffing and health inspections, plus an overall score.

The ratings are based on inspection records, complaint investigations and specific quality measures, such as how many nursing staff hours were provided each day to patients, how many patients developed bedsores and how many were placed in restraints. For a five-star rating, homes had to provide at least four hours a day per patient of care by registered nurses and other nursing staff. While those looking at the ratings may tend to give more weight to the overall rank for a facility, a home with a low overall rating — less then three stars — might have higher scores on individual categories. Rather than simply looking at overall ratings, consumers should study the individual categories and consult other data.

Acting Medicare Administrator Kerry Weems says offering information in a simple, five-star format should prompt "a national conversation about nursing home quality" and spur homes to improve. While the rating for any particular home might be subject to dispute, taken as a whole, the rating system suggests improvement is in order. Nationally, 23 percent of homes received the lowest rating — one star — for overall performance. North Carolina fared somewhat worse, with more than 25 percent receiving only one star. Of the nine nursing homes listed for Rowan County, four received an overall rating of one star, while two received either a four- or five-star rating.

The new federal ratings and a similar state system to be unveiled later this month are useful tools for consumers researching care home. But the key word is research. Visit care homes. Observe the conditions of the facility and the interactions between staff and residents. Ask questions. And realize that even after you've selected a home for a loved one, it's important to make frequent visits, monitor care and be an advocate for competent and compassionate treatment.