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Get ready for industry scorecards.

To date, the nursing home industry has not been enthusiastic about the use of scorecards to help consumers evaluate nursing homes. When Consumer Reports published detailed ratings of major nursing home chains last year, representatives of the rated facilities responded with an intense critique of the rating methodology. When a former nursing home administrator published a national book of survey results, nursing home spokespersons claimed that the survey findings were incomplete and outdated. When the Health Care Financing Administration (HCFA) posted recent survey findings for the nation's nursing homes on a World Wide Web site, the nursing home industry raised concerns that the information was poorly presented and difficult for consumers to understand. When local newspapers have published reports of nursing home quality, statewide nursing home associations urged their members to write letters to the editor offering a counterpoint message.

Scorecards, report cards and rating systems are intended to serve as an understandable means of communicating the quality of products or services to the consuming public. Consumers have come to rely upon a "seal of approval," such as those awarded by Good Housekeeping and Underwriters' Laboratories, or a "best buy" recommendation when purchasing household appliances, selecting municipal bond investments, deciding to view movies and choosing hotels. Consumers have learned to judge various products and services by grades of "A" through "F," "thumbs up" or "thumbs down," scales of 1 to 10 and "1-star" to "5-star" rating systems.

Why, then, shouldn't consumers expect to be able to review ratings of nursing homes when choosing a care setting for a beloved family member? While insiders in the nursing home industry realize that 30 deficiencies reflect poorer quality care and one deficiency may be a decent survey result, family members and prospective residents are not as sophisticated at differentiating between good and poor quality care based solely upon survey results. Insiders also know that a deficiency with a scope and severity rating of "K" is much more serious than an "E" deficiency; consumers may not readily grasp the difference. Unfortunately, survey results are often inconsistent from one state to the next and sometimes even within a single state, making it even more difficult for family members in California to rate the quality of care in Massachusetts nursing homes.

Imagine for a moment that you are considering the purchase of a digital videodisc (DVD) player, a new technology for playing movies. Imagine further that the sales consultant tells you that there are 188 different features that may influence your purchase. Since a DVD player is a new technology, you may not know or understand the nuances of the 188 features. The sales consultant asks you whether you are concerned most about price, video quality, sound quality, size compatibility with other technology, location of the manufacturer or a myriad of other features.

How would you choose a DVD player? You might rely upon the recommendation of a friend, but most of your friends probably haven't yet purchased a DVD player. You might hire a video technology expert to recommend a DVD player, assuming that you know how to locate such an expert and that you can afford to pay for his services. You might visit several electronics stores to view firsthand the available models of DVD players, hoping that you will recognize a quality product when you see it. You might read a local newspaper or watch a television news program to learn if a media technology expert has already deciphered the differences among the available models. Or, you might purchase a copy of Consumer Reports to read the results of testing performed by their independent laboratory.

So, if a daughter needs to select a nursing home for her mother who is being discharged from the hospital in four days, how does she know which nursing home to choose? Currently, most family members use a few simple criteria to evaluate a nursing home. First, which nursing home is geographically close enough to family members to enable them to visit frequently? Second, which facilities does the hospital's discharge planner recommend? Third, if the prospective resident is privately insured, which facilities are approved members of the insurer's network? Fourth, which nursing homes are recommended by others, such as a clergy member, neighbor(s), friend(s) or the family physician? And, fifth, how much will nursing home care cost, including daily room rates and therapy services?

Traditionally, the nursing home industry has assumed that consumers will be satisfied with a nursing home that holds a valid state license, maintains federal Medicare and Medicaid certification and perhaps secures private accreditation. But these criteria alone do not help consumers make choices among several similar nursing homes. Adding further to consumer confusion is the plethora of terms used in many states, such as subacute, skilled nursing and intermediate care.

Even providing a copy of a narrative survey report or HCFA-2567 may not fully inform consumers, because of difficulty in understanding medical jargon and legalistic regulatory language. Some consumers maybe alarmed about a single deficiency; others may not be worried about 15 deficiencies. Further, state survey agencies use phrases such as "substantial compliance," "substandard quality of care," and "immediate jeopardy" to designate a specific compliance status, and these terms are not always understood by consumers.

If we want consumers to make informed choices about the nursing home they select, then it is time for us to stop criticizing others' efforts to report on the quality of our industry. Ignoring the existence of scorecards will not make them go away. Ignoring the existence of a few poor-quality nursing home providers does not improve the reputations of the many good-quality nursing homes. We must create a fair and effective scorecard system by working with consumers and their representatives. Why not do it ourselves, do it right and do it now?

What do you think?

Beth A. Klitch, FACHCA, is president of Survey Solutions, Inc., Columbus, OH. For further information, phone (514) 488-1280; write c/o Nursing Homes/Long Term Care Management; or fax (216) 522-9707.
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Title Annotation:evaluation of nursing homes
Author:Klitch, Beth A.
Publication:Nursing Homes
Date:Feb 1, 1999
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