Doll: Look beyond ratings when choosing nursing home
Thursday, January 22, 2009
Although a new nursing home quality rating system has several dimensions, experts say it fails to address perhaps the most important question: Are the residents who live there happy?
When choosing a nursing home, Gayle Doll, director of the Center on Aging, suggests visiting the facility in the morning. If some of the residents are still sleeping while others are eating breakfast, that's a sign that they're determining their own schedules rather than doing what's easiest for staff.
"If the staff is bent on people having to be in a certain place at a certain time, it's not a people-centered home," Doll said.
Ratings don't tell complete story
She and fellow researchers at the center said that government ratings like the five-star system instituted by the Centers for Medicare and Medicaid don't necessarily reward nursing homes for offering a homelike setting and giving residents as much freedom as possible.
Stephanie Gfeller, a research assistant at the Center on Aging, said that consumers are familiar with a five-star rating system for other services like restaurants and hotels, which seemingly makes it easier to understand. But Gfeller said that the system can penalize nursing homes that recognize problems and are working to address them. For instance, she said a nursing home may receive a poor quality measures rating related to incidents of pain if it reports a lot of residents in pain, even though the staff may be doing so because they want to monitor and solve the problem.
Do residents have as much freedom as possible?
Doll said the freedoms that make many people happy -- having a beloved pet, enjoying a cocktail or decorating a room as they see fit -- aren't necessarily reflected in ratings that emphasize a perception of safety, often at the expense of freedom.
"A resident might be really, really happy in a three-star home but not so in a five-star home," Doll said.
The researchers said there are a few things future residents and their families can look for to determine whether a nursing home offers people-centered care:
- Are schedules built around an individual resident's wishes, not staff preferences or arbitrary policies? Do residents choose when and how often to bathe? Can they get a snack or drink from the kitchen in between meals? Can they get a preferred food item? Are visitors welcome at any time?
- Are the same staff people routinely working with the same resident? What's the turnover rate for staff? Ask direct care staff how they like their job. "You'll get a feeling whether they like it or not," said Laci Cornelison, a research assistant at the Center on Aging. To get a more complete picture of how the staff interacts with residents and families, ask visitors whether they feel like they can communicate openly with staff. "They're usually pretty honest," Gfeller said.
- How well is the privacy of residents respected? Are there places where residents can be alone? Does staff knock and ask permission before entering a room?
- Are residents engaged in activities on the weekends when regular staff is gone? If someone has a special interest or hobby, is there a place where he or she can engage in this? Do residents participate in unscheduled activities, even if it's an everyday task like helping with meal preparation or housekeeping?
The ice cream cone test
Gfeller said a scenario that future residents or families can think about is what it would take for a resident to get an ice cream cone. In some facilities, this could mean getting permission from various caretakers, withdrawing money from the resident's account at the business office, finding transportation, and then several days later finally getting an ice cream cone.
In a people-centered nursing home, Gfeller said, the process might be as simple as asking, "Who else wants to come?"
"The choice of a nursing home usually comes when someone is in the hospital, and often times the doctor makes a suggestion or one is chosen based on convenience of location," Doll said. "What we're trying to get people to understand is that they need to have this conversation long before the need occurs."
It's important to ask a potential resident what he or she would choose, Doll said. "You might start the conversation by asking, 'If you're injured and you can't stay at home, where do you want to go?' If you present it as a temporary situation, it might be easier to talk about," she said.
Researchers suggest resources
K-State researchers also suggest the following resources that future residents and families may find helpful:
- The book "The New Nursing Homes: A 20-minute way to find great long-term care" by Marilyn Rantz, Lori Popejoy and Mary Zwygart-Stauffacher, which includes questions to consider during a walk-through of a nursing home, while interviewing staff members and when talking with family members of other residents.
- Things to look for in a people-centered nursing home can be found through the Promoting Excellent Alternatives in Kansas Nursing Homes initiative, a joint project of the Kansas Department on Aging and K-State's Center on Aging
- Kansas Association of Homes and Services for the Aging
- Kansas Health Care Association
- Kansas Department on Aging and the 11 Area Agencies on Aging
- Kansas Advocates for Better Care
- Kansas long-term care ombudsman's office
News release prepared by: Erinn Barcomb-Peterson, 785-532-6415, firstname.lastname@example.org