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Member Research and Reports

Member Research and Reports

Colorado: Consumers Reveal Obstacles to Nursing Home Ratings

A study of 63 people who placed a relative or friend in a nursing home in the previous six months found that few people were aware of the website Nursing Home Compare, published online by the Centers for Medicare and Medicaid Services (CMS) to help families find the best and closest available facility.

The study, conducted by researchers Dr. Marcelo Perraillon at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus and Dr. Tamara Konetzka the University of Chicago, found that those who viewed the website often did not trust it, at least initially.

Many were interested in questions that the website did not answer, such as how to find a nursing home that was affordable, offered multiple activities for residents and had beds available for people who rely on Medicaid. Most of those interviewed understood the importance of staffing but showed little interest in the core clinical-quality measures such as pain management, the use of restraints, and prevention of pressure sores, infections and falls.

CMS launched the five-star version of their web-based Nursing Home Compare (NHC) in December, 2008, to help families find the best available nursing home. The system is designed to combine multiple measures into a simplified five-star rating. Five stars mean “much above average.” One star indicates “much below average.”

NHC collects data from all CMS-certified nursing homes in the United States and splits the information into three categories: results from periodic health inspections, staffing ratios per patient, and a cluster of clinical quality measures. Then, they combine the data to produce an overall rating.

A lot has changed since Nursing Home Compare was introduced online in 2008, the authors note. Studies from 2003 and 2006 mention limited use of the internet by families choosing a nursing home, but the current study, ten years later, found that “almost all respondents had access to the Internet and used it in their decision-making process.” The current study also found greater emphasis on costs and on how to gain access to high-quality nursing homes for those dependent on Medicaid, who make up 60 percent of nursing home residents.

The authors suggest ways to overcome some of NHC’s problems, such as the lack of awareness. It is costly to advertise a product that people may not anticipate needing, they note, but the widespread growth of internet use, with a boost from traditional sources of information such as family, friends, and health care providers, should slowly raise awareness and help consumers distinguish between verified data and corporate boasting.

They urge CMS to highlight their role in collecting the data for Nursing Home Compare and to make it clear that they, and not the nursing homes, maintain the website and, increasingly, collect the data. CMS could also improve the website’s appeal, they suggest, by adding more information about costs, inserting opinions from nursing-home residents about the quality of their experience, and quantifying the availability of activities for residents.

The authors also encourage families to find a nursing home that meets their loved one’s particular needs and to visit several nursing homes to see how they treat residents. One nursing home resident they surveyed recommended surprise visits.

The Agency for Healthcare Research and Quality funded this project.

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