Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

Finding a high-quality nursing home for a family member is a daunting task.

Many people have not had to make this decision before. And it's often made under stress, when asking good questions and thinking carefully about your options are harder than usual.

Fortunately, more information is available that can help you learn about nursing home quality and prepare you to make a well-informed decision.

Start this process with an online tool from the Federal Government called Nursing Home Compare. This lets you look up nursing homes in your area by name, city, county, State, or ZIP Code. First unveiled in 2009, Nursing Home Compare has detailed information on every nursing home certified by Medicare or Medicaid.

Nursing homes are rated using a 1- to 5-star scale, with those earning 5 stars being rated the highest. Ratings are based on how many and what type of staff members they have, how well they perform on health inspections, and how they rank on quality measures. Ratings for each measure are given individually and are also combined into an overall rating.

Starting in 2012, Nursing Home Compare will include a new measure that includes input from the nursing home residents. This new information will take the place of the quality measures that currently appear on Nursing Home Compare. Findings will be part of the ratings starting in April 2012.

Staffing and health inspection data add important information and will continue to be a factor in each nursing home's overall rating. The staffing measure tells you the average staffing levels—such as the number of registered nurses, licensed practical nurses, and certified nursing assistants—for each resident each day. This is a good benchmark, but it has limits. It does not show the number of nursing staff present at any given time or describe the amount of care give to any one resident. The health inspection measure looks at many major aspects of care in a nursing home. This includes how medicines are managed, whether food is prepared safely, and whether residents are protected from inadequate care. Inspections take place about once a year, but they may be done more often if the nursing home has several problems to correct.

Even with so much good information, the Nursing Home Compare tool and rating system won't answer all of your questions. For example, the ratings won't tell you if the nursing home has improved, or gotten worse, in certain areas since it was rated. That's why it's important to visit any facility you are considering. Be sure to ask questions of the staff, especially people who provide care to residents. It's also a good idea to visit a nursing home a second time on a different day of the week and another time of day. You may get a better idea of changes in staff, activities, and other factors that could make a difference in your choice.

An excellent list of questions to ask during such visits is available from a nursing home checklist (PDF File; Plugin Software Help) by the Centers for Medicare and Medicaid Services (CMS). And a new handbook (PDF File; Plugin Software Help) from CMS explains how to pay for nursing home care, describes residents' rights, and gives alternatives to nursing home care. Another good resource is your State ombudsman; select to find yours.

We have come a long way in our efforts to improve the quality of care for nursing home residents. But we still have work to do, especially when it comes to creating a setting that encourages staff to report problems without fear of blame, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). The majority (86 percent) of nursing home staff interviewed for the report said that residents are well-cared for and safe. However, about half said that staff are blamed when a resident is harmed.

I'm excited to see the progress that nursing homes have made in measuring and improving quality. Best of all, that information is available to help you make a good choice.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Centers for Medicare and Medicaid Services
Nursing Home Compare
http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteriaNEW.asp?version=default&browser=IE%7C8%7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True

Quality Measure
http://www.medicare.gov/NHCompare/static/tabhelp.asp?language=English&activeTab=4&subTab=0&version=default
 

Nursing Home Checklist
http://www.medicare.gov/nursing/checklist.pdf 

Guide to Choosing a Nursing Home
http://www.medicare.gov/Publications/Pubs/pdf/02174.pdf 

Agency for Healthcare Research and Quality
Nursing Home Survey on Patient Safety Culture
http://www.ahrq.gov/qual/nhsurvey11/

National Long-Term Care Ombudsman Resource Center
Locate an Ombudsman and State Agencies
http://www.ltcombudsman.org/ombudsman 

Current as of December 2011
Internet Citation: Tools Help You Choose a Good Nursing Home. December 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/120611.html