Nursing Homes: US Tries to Rate Them, With Mixed Success

ONE of the most agonizing tasks anyone faces is selecting a nursing home for a relative in need. In an effort to aid those Americans facing this challenge, the United States has just published massive tomes of information about individual American nursing homes, for the second time in two years. State by state, in 93 telephone-sized books, the federal government has published the pass-or-fail rating that state inspectors gave to every one of the 16,000 American nursing homes that participate in the government-financed Medicare and Medicaid programs to aid the elderly and the poor. In a state inspection during the past two years each nursing home was rated on 500 requirements; the book takes into account 32 of them, which range from residents' privacy and freedom from abuse, to cleanliness to safe food storage and preparation.

Almost everyone agrees the books are far from perfect. But authorities disagree on whether they actually can help. Their assessments are much like disparate views of the proverbial glass of water: To some it seems partly full, to others partly empty.

``We're very pleased,'' says a spokesman for the American Association of Retired Persons, the largest organization of older Americans. ``We think that it can provide some very useful information to the consumer,'' he adds. He notes improvements since the December 1988 report, including a notation of whether any government agency took enforcement action to get the nursing home to stop violating standards - ``a red flag for someone to inquire into.''

The Department of Health and Human Services, which produced the books, admits the information is only a start in a complicated assessment process. But HHS says the data should help consumers realize at least what information they need to know about a nursing home. In the front of each book HHS lists several dozen questions that consumers ought to ask about a nursing home.

Paul Willging says the books do not present a reliable picture of nursing homes, in part because they involve subjective judgments by many people, make permanent judgments based on conditions that may have existed on one day only, and are based on information never intended to be used for this purpose. Mr. Willging is the executive vice president of the American Health Care Association, which represents 10,000 US nursing homes.

Willging sees three other deficiencies: 1. It does not tell whether a problem is important (a deficiency HHS acknowledges), or whether it represents a one-time deficiency or a consistent pattern. 2. It's outdated - some data could be as much as two years old. 3. The data are very inconsistent - assessments apparently vary from state to state.

In addition, a check in two states turns up an apparent error in use of statistics, which could mislead anyone trying to compare ratings of individual nursing homes against the national average. In the Rhode Island and Virginia nursing-home guides, two different sets of statistics are used, repeatedly, to represent the percentages of nursing homes across America with deficiencies. How well a nursing home compares to the national average depends on which set of statistics a reader is looking at.

The differences between the two sets of statistics can be sizable. For instance, one says no nursing home in the US failed to keep patients isolated to prevent spread of infection; the other says one in every five nursing homes failed this test. Similarly, according to one set of statistics one in 10 nursing homes failed to keep common areas clean and free of odors; the other raises the failure rate to one in five.

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