US tries its hand at rating America's nursing homes. But critics say standards used must be improved

New federal ratings of America's 15,000 nursing homes are like the old children's game, ``Mother May I.'' Uncle Sam hopes the information, made public yesterday, will be a giant first-step toward helping Americans choose which nursing home to use. But critics say the ratings are at best a baby step forward, and federal officials admit they have serious shortcomings.

In any case the ratings are part of an effort by William Roper and other officials of the Department of Health and Human Services (HHS) to help citizens choose medical facilities by providing them with more information about individual facilities. Last year Dr. Roper, director of the department's Health Care Financing Administration, released a similar report on hospitals. It, too, suffered considerable and similar criticism.

Paul Willging, executive vice-president of the American Health Care Association, America's largest trade association of nursing homes, applauds Roper's intent in making public information about individual nursing homes.

``The good news,'' Dr. Willging says, is that ``information is critical'' in helping people choose which nursing home is best for a parent or spouse in need. ``The bad news is this doesn't do it.''

The data, he says, were not intended to help select a nursing home, nor are they useful in doing so. What the government ought to do to be really helpful to Americans, he says, is twofold:

Produce ``a really effective guide on how to visit a nursing home,'' including a checklist of what to look for. Willging and other experts say that, in his words, ``there's no substitute for visiting a nursing home'' in deciding which one to select.

Change the standards used to rate nursing homes so that they emphasize what actually matters most - how people are treated and how they are feeling. Too many of the current standards are far less important, and there are too many.

On this last point federal officials largely agree. Roper says the ``principal'' change that's required is to judge nursing homes on ``what really happens to patients,'' rather than on less important issues, such as the width of hallways. The government is in the process of changing the 500 questions on which it rates nursing homes to reflect this view.

The ratings produced this week are based on the current 500 standards on which Uncle Sam rates nursing homes. ``Many of these'' standards, Roper says, now ``are process questions - how the process of care was carried out, as opposed to the actual care of the patients.''

A further problem with the current ratings, says HHS's Thomas Morford, is that they are either pass or fail: nothing shows whether a nursing home failed to pass a standard, such as having the requisite number of nurses, by a narrow or very wide margin. Mr. Morford is director of the health standards and quality bureau of HHS's Health Care Finance Administration.

Nevertheless, Morford and other federal officials insist, the new state-by-state ratings constitute a useful user's guide to deciding into which nursing homes to place friends or relatives. ``It tells people all kinds of things to ask'' when they visit a facility that they are considering.

Like other experts on nursing homes, Roper says that ``America's nursing homes are better than ever before.'' But he adds that the new information ``shows significant problems that need to be dealt with across the country'' - from food preparation to the adequacy of nursing staff.

Problems there are, Willging agrees.

But he says that the ratings utterly fail to address the fundamental problem: namely, that payments to nursing homes, especially by medicaid and other government programs, are not high enough to enable the facilities to hire qualified staff - sometimes, not enough staff of any quality - to provide top-quality care.

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