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 Nursing Home Compare, on the Medicare.gov web site, lets users find
and compare nursing homes certified by the U.S. Centers for Medicare
and Medicaid Services (CMS). (http://bit.ly/2GhedTA ) The tool does
consider some measures of patient safety, but safety doesn't seem to
factor much into the site's rating system and details can be
difficult for consumers to dig out, researchers say in a report in
Health Affairs.
"Nursing Home Compare has been helping consumers choose nursing
homes for around two decades," said the study's senior author, R.
Tamara Konetzka of the University of Chicago. "Some standard patient
safety measures - falls, UTIs, and pressure sores - are indeed on
NHC," she said. "However, they don't play a large role in
determining the overall star levels, which is why we say that NHC
does not reflect patient safety well. Most consumers just look at
the star levels, which does not give them much information about
patient safety."
The information on Nursing Home Compare comes from three key
sources: the CMS health inspection database, a national database of
resident clinical data known as the Minimum Data Set, and Medicare
claims data.
While it wasn't hard for Konetzka and colleagues to find information
on such safety issues as bed sores, urinary tract infections and
falls, medication errors were another story. "If you're interested
in avoiding a place with a lot of medication errors and want to know
which nursing homes did well on that, you'd have to dig deep, get
into the actual inspection reports and know what you're looking
for," Konetzka said. "It's a level of depth I don't think many would
know how to do."
The researchers analyzed data on all 15,652 nursing homes in the
U.S. that are certified by Medicare, Medicaid, or both. Along with
information from Nursing Home Compare, the researchers looked at
data from Certification and Survey Provider Enhanced Reporting
(CASPER) for the first quarter of 2017.
CASPER is a compilation of data collected by surveyors during
regular inspections of nursing facilities for Medicare and Medicaid
certification. From CASPER, the researchers obtained profit status,
payer mix, chain status and whether the nursing home had been cited
for medication errors in its most recent health inspection.
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At the extremes, Konetzka said, there did seem to be some
correlation between safety issues and a nursing home's star rating,
albeit a weak one, but that wasn't true for the mid ranges: two
stars to four stars.
The current system "leaves families sort of flying blind," said Dr.
Albert Wu, an internist and professor of health policy & management
at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
While factors "such as staffing ratio are important, this isn't
really telling me anything about safety. And I think one of the main
reasons people decide they need to move a loved one to a nursing
home is it's no longer feasible or safe for them to be cared for at
home. So certainly one of the first things you want to know is, is
this going to be a safe place."
Many of the questions people typically have about nursing homes
aren't addressed by the Nursing Home Compare system, said Wu, who
was not involved in the new research. "Most important is, would I
want to live here," he added. "And then, are the residents happy and
alert? Are there activities for the residents? Does the facility
look and smell clean? What are the interactions between staff and
residents like?"
"All of that information could be captured in a nursing home's
rating," Wu said.
While the current version of Nursing Home Compare is a good first
step, Wu said, "much more is needed to provide people with the
information they want and need."
SOURCE: http://bit.ly/2F7adbS Health Affairs, online November 5,
2018.
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