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At one of my previous employers, we had a saying: "It is important to do some 'ground-truthing' before drawing any conclusions." Ground-truthing is, of course, going out into the field and seeing the place with your own eyes because you cannot take as gospel what you are told by others. A recent article from Reuters Money applies this principle to selecting a nursing home.

It is true: According to a GAO study, for-profit nursing homes "more frequent and serious deficiencies than non-profit homes." You need to "peek behind the curtain" and look behind the numbers when selecting an appropriate facility for you or a loved one.

In a previous post, I discussed the Medicare "Nursing Home Compare" website and the excellent information it provides. The NHC, however, should be a starting point for your research, not the "be-all-end-all" of it.

As suggested in my prior posts, and as reiterated by my colleague Jonathan Rosenfeld and others in the Reuters' article, in-person visitation to a nursing home during the selection process is just as important as the "numbers." Go to various facilities. Go unannounced if you would like. Look around. Is the facility clean no matter what time of day or night you visit? Do the residents look neat and clean or disheveled? Do the residents seem happy or over-medicated? Visit at meal-time; try out the food.

Choosing the right nursing home is a big decision. Do not rely upon "numbers" alone. Do not simply take the recommendation of someone, whether they are a friend or not. You wouldn't buy a car based on MPG and recommendations, would you? You need to "kick the tires" to make sure the car you are considering is the right one for you. You take it for a test drive. Shouldn't you do the same when making the decision of which nursing home is right? The answer is undoubtedly: Yes!

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An article in today's Idaho Statesman, "Nursing Homes Across the Treasure Valley Rehab Their Image," caught my eye. The article, written by Kristin Rodine,  begins with the following paragraph: "Flat-screen televisions, Wi-Fi access and a state-of-the-art therapy gym are just a few of the ways Life Care Center at Valley View has upgraded its long-term care unit to transcend the traditional nursing home label." The article goes on to discuss facilities making themselves more attractive to the consumer. A slick marketing tool to be sure. Afterall, first impressions are lasting impressions.

Now, flat screen televisions and Wi-Fi access are nice and all; in reality, however, the care received is the thing! We all enjoy amenities, but if the facility is not staffed adequately, or if the staff is not trained properly, all the gadgets in the world won't make your experience at a nursing home or assisted living facility safe.

Immediately after reading Ms. Rodine's article, I jumped on Medicare's "Nursing Home Compare" website and checked out Life Care Center at Valley View's 5-star rating. I was pleasantly surprised; according to Medicare, the facility has a 5-star rating -- the highest rating available. This is not to say Valley View is perfect. During an inspection on December 18, 2009, the facility was cited for failing to "give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores." I doubt any facility in Idaho, or the nation, however, is perfect.

At the end of the day, simply reading Ms. Rodine's article or, for that matter, visiting a nursing home or assisted living facility is not enough. You need to do further research to make sure the facility will give you good, professional and adequate care. As the old saying goes: You can't judge a book by its cover. After inspecting a nursing home, you need to do more...kick the tires and check under the hood. You would if you were buying a car! Do your research so you or a loved one is in a facility appropriate to their needs and desires.

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In an article in today's New York Times, reporter John Leland, describes the cuts states are making to close budget gaps and the effect those changes are having on the elderly. Some of the cuts described by Mr. Leland include meal deliveries, housekeeping assistance and aid for family caregivers. 

As Mr. Leland correctly points out at the beginning of his article, such cuts are "penny wise and pound foolish" (my words not Mr. Leland's) because the programs being cut have demonstrated they actually save states money by keeping the elderly at home and not in expensive nursing home and assisted living facilities. Interestingly, Bruce Goldberg, the director of the Oregon Department of Human Services, inadvertently demonstrated the very problem with attempting to balance Oregon's budget on the backs of its elderly and infirm population. According to the article, Mr. Goldberg said: "[T] he agency did not have an estimate for how many of the people losing home care would end up in assisted living facilities or in nursing homes -- or, if they did, how the state would pay for them."

Is it right for Oregon and other states to balance their budgets in such an irresponsible manner? I will leave that for you to decide (although, perhaps, the way I phrased the question reveals my answer). More importantly, to the extent those loosing the financial assistance for home care need to take adequate steps ahead of time to properly research nursing home and assisted living facilities in order to ensure when the time comes, they are placed in a safe, nurturing and caring facility. A facility that is able to adequately care for their needs. 

A new wave of nursing home and assisted living facility residents are being created by state budget cuts. The question remains, will the facilities be able to handle the deluge of new residents? Only time will tell. 

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Last week, I made the argument that Idaho nursing homes should voluntarily post their Medicare "Five Star" ratings. California has enacted a law requiring facilities to post these ratings, it was my hope that Idaho facilities would voluntarily do so. Since making my argument, I have done some research on Medicare's ratings for Idaho facilities. All I can say is "shame" to many of the facilities in Idaho. It is no wonder facilities in our fair state do not voluntarily inform the public about their Medicare "Five Star" ratings; in many cases, those ratings are nothing short of dismal.

According to Medicare's website:

• 79 nursing home facilities in Idaho;
• 77 nursing home facilities with ratings;
• 14 nursing home facilities have Medicare's highest rating - 5 stars;
• 13 nursing home facilities (17 % of those with ratings) have Medicare's lowest "much below average" rating - 1 star;
• 13 nursing home facilities (17% of those with ratings) have a "below average" rating - 2 stars.

To the facilities with 5 star ratings I say: Keep up the good work. To those facilities with ratings of 2 stars or below, a shocking 34% of facilities in Idaho, I say: Shame on you. Why would a knowledgeable person voluntarily put themselves or a loved one in your care?

Please, before you make a decision on which nursing home is right for you, do your homework. Check the Medicare "Nursing Home Compare" website. Use the other resources available to you. Remember, knowledge is power - the power to choose a safe environment and the power to hold nursing homes accountable for their poor performance before you or a loved one becomes a victim.

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In a previous post entitled "Reliable Internet Resources For Choosing A Nursing Home," I linked to Medicare's "Nursing Home Compare" website. Through the Nursing Home Compare website, you can access and view a facility's "Five Star" rating. According the Medicare:

"The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions. This rating system is based on continued efforts as a result of the Omnibus Reconciliation Act of 1987 (OBRA '87), a nursing home reform law, and more recent quality improvement campaigns such as the Advancing Excellence in America’s Nursing Homes, a coalition of consumers, health care providers, and nursing home professionals."

From the link I posted, it takes approximately five (5) "clicks" to get to the faciilty's rating. Shouldn't it be easier than having to go through Medicare's website to find a facility's Five Star rating? The folks in California think so. That is why a new law was passed that requires nursing home facilities, beginning in January 2011, to post their rating. According to Los Angeles County Supervisor Michael Antonovich: "This posting system provides vital information for families to make informed decisions about the care for their loved ones and provides incentives for nursing homes operators to establish and maintain high-quality standards of care and compliance."

Now, I'm generally not in favor of more laws. There are, of course, exceptions to every rule. You have to wonder why nursing homes would not voluntarily post their Five Star ratings. After all, aren't they something to be proud of? If not, why isn't the facility doing something to "fix" the problems it has?

Come on, Idaho nursing homes, do you need a law requiring you to post your ratings or will you do the right thing for your potential residents and conspicuously post your Medicare ratings for all to see? Don't you want to provide this information to those shopping for the best nursing home around? Really, what do you have to hide?

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The Idaho Department of Health and Welfare, Bureau of Facility Standards is the state agency that conducts "surveys" of Idaho's nursing homes to make sure they are in compliance with all applicable federal and state regulations. It may surprise you that in the most recent survey available, for the period of January through June 2009, there were seven (7) citations issued for facilities who hired staff "guilty of abuse." Although this may not seem like a large number of citations, remember two things: (1) This survey was for a six month period; and (2) There were only 64 surveys conducted.

What drives facilities to make such an egregious and potentially harmful hiring decision? First and foremost, facilities often do not conduct appropriate and thorough background checks on applicants. Second, many facilities do not pay for quality staff and, thus, they "scrape the bottom of the barrel" of the employee pool. Third, some facilities simply need to "fill the void" when existing staff leave and may believe that some staff is better than no staff. Of course, none of these "excuses" for hiring staff "guilty of abuse" are "reasons" for substandard hiring practices.

Before choosing a nursing home, make sure you ask the appropriate administrator what type of background checks are conducted on potential employment candidates. Also ask if the facility has received any citations from the Idaho Department of Health and Welfare's Bureau of Facility Standards. If the facility has received any citations, ask to see them and what the facility did to correct its conduct.

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Are you choosing a nursing home for yourself or a loved one? You need to be comfortable and knowledgeable. There are numerous websites to assist you.

The United States Department of Health and Human Services' Medicare nursing home website is an excellent place to start your quest for knowledge. There, you will find a link called “Nursing Home Compare.” You can use this website to compare nursing home facilities in your area. You can also compare the quality of nursing homes you are considering. A “Nursing Home Checklist” is available if you are going to be visiting a facility.

In Idaho, you have additional choices for researching potential nursing homes. You can contact the Idaho Commission on Aging to help you in this most important decision. There you will find information about the Ombudsman program as well as a link to the Bureau of Facility Standards, where you can review results of surveys of long term care facilities in Idaho. A copy of the most recent survey results lists 84 facilities throughout Idaho. The survey includes complaints, violations discovered during inspections and a facility’s response to these things.

The "Nursing Home Checklist" is an excellent resource for when you go to various facilities to investigate which facility is the right one for you. For example, the beginning of the Checklist focuses you on whether the facility actually has the appropriate level of care you or your loved one requires. Remember, no matter how nice a facility or its staff is or appear to be, if the appropriate level of care (skilled nursing vs. custodial care) that facility is simply not the right one for you or your loved one. Choosing an inappropriate facility can lead to numerous problems, not the least of which is injury to you or your family member.

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