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Nursing Home Compare or How do I choose which nursing home to go to?

Anthony Szczygiel, Professor of Law, University at Buffalo School of Law

Published February 25, 2014

“Memo to my family and future guardian: I don't want to reside in a nursing home. But if I do, I certainly do not want to be in a one-star rated facility. Or a two-star or three-star rated facility. Thank you.”
Anthony Szczygiel, Professor of Law
University at Buffalo School of Law

Medicare's Nursing Home Compare website provides a way of measuring and contrasting the performance of skilled nursing facilities throughout the US.  See, http://www.medicare.gov/nursinghomecompare.   The information is helpful when individuals are choosing which nursing home to enter.  Nursing Home Compare rates each facility in three categories, Quality Measures, Staffing and Health Inspections.  The ratings are based on relatively hard data - aggregated resident-specific Minimum Data Set (MDS) information that the facilities must chart for all residents (re: falls, bed sores, mobility improvement or decline, rate of incontinence, UTIs, use of restraints etc); actual number of employees (RNs, LPNs, CNAs) per resident and the findings of recent State Health Department inspections.  In each category, the facility is rated on a 1 to 5 star scale (1 is much below average, 5 is much above average), and then an Overall rating is assigned.

 

Medicare just released version 3.0 of this rating system, adding some refinements and making it somewhat harder to get a 2 star or higher rating.  http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-12-2.html.  Among the changes, Medicare added 2 nursing home quality measures for antipsychotic use, and changed the scoring method for the Staffing star rating. Nursing homes must earn a 4-star rating on either the RN or total Staffing rating to achieve an overall Staffing rating of 4-stars. The New York Times reports: "Before the change on Friday, about 80 percent of the nation’s nursing homes received a four- or five-star rating out of five on their quality measures score; afterward, nearly half did. The number of homes receiving one star in that area increased to 13 percent, from 8.5 percent, after the recalibration." http://www.nytimes.com/2015/02/21/business/nursing-home-ratings-fall-as-tougher-standards-take-effect.html?_r=0.

I recommend looking behind the overall rating, to the actual data.  For example, in the staffing category the website tells me that the NY average for RN Hours per Resident per Day is 45 minutes, LPN/LVN Hours per Resident per Day is 51 minutes and CNA Hours per Resident per Day is 2 hours and 23 minutes.  A 4-star facility may have great staffing, but have had a bad inspection report, for violations that have been corrected. 

There are 43 nursing homes within 25 miles of my house.  5 facilities get 5-star ratings  Autumn View (Hamburg), Briody (Lockport); Elderwood at Wheatfield (Niagara Falls); Harris Hill (Williamsville) and Seneca (West Seneca).  Some of the better promoted or more costly facilities fall in the middle (Canterbury Woods, 4-stars;  Rosa Coplon, 3-stars; Fox Run and HighPointe (BGH's new facility), 2-stars.)  Nine local facilities get one-star ratings:  The two Absoluts (Orchard Park and East Aurora); Emerald North and South (Delaware Avenue, Buffalo); Niagara Rehabilitation and Schoellkopf (Niagara Falls); Terrace View (ECMC's new facility) and two of the three Legacy Health Care facilities, Williamsville Suburban and Ridge View (Dorrance Avenue, Buffalo).  Legacy’s third facility, Sheridan Manor get a 2 star overall rating.

Memo to my family and future guardian:  I don't want to reside in a nursing home.  But if I do, I certainly do not want to be in a one-star rated facility.  Or a two-star or three-star rated facility.  Thank you.