Vast Majority of Nursing Homes Have Violations — Are They Dangerous? How to Tell

If you have a loved one in a nursing home or think the day might soon arrive that you need to make such a decision, you’ll want to know that a recent review of citations for violations of federal health and safety standards found that more than 90% of for-profit and government-run homes and 88% of non-profit homes were cited for “deficiencies.”

With 1.5 million Americans residing in the 16,000-plus nursing homes in this country, these findings are both meaningful and disturbing — they prompted me to seek expert advice for consumers exploring their options in nursing-home care.

Kenneth Boockvar, MD, a physician at the Geriatrics Research, Education and Clinical Center at the James J. Peters VA Medical Center, Bronx, New York, and at Jewish Home Lifecare, a nursing home in New York City, is an expert on this subject. Agreeing that these findings are important, Dr. Boockvar also notes the difficulty of extrapolating the effect on individual patients from deficiency data presented in reports. There are more than 100 possible deficiencies and in this particular report, they ranged from purely administrative, such as writing and setting up policies, to crucially important for patient care, such as prevention of pressure sores.

AN INFORMED SEARCH

You can easily find the number and kinds of deficiencies that have been reported for an individual nursing home at the government’s Medicare site (www.medicare.gov, click on “Compare Nursing Homes in Your Area”). This site also presents ratings using the government’s new five-star system (five being the best), based on information from health inspections, staffing and quality measures. Most important, Dr. Boockvar says to look at the nursing staff hours per patient — he recommends nursing homes with four- or five-star ratings on nursing staff hours, pointing out that there is quite a difference between having three hours per resident per day compared with just two. Another factor to consider is that not-for-profit nursing homes have consistently had higher quality ratings than for-profit nursing homes in reports over the years.

PAY A VISIT

After you have culled options from the Medicare list, it’s important to personally visit each of the homes under consideration. Keep in mind that homes are designed to meet different sorts of needs. They often specialize in care for specific types of patients, which affects everything from physician and nurse staffing to activities and what the facilities look like.

Here are some examples:

  • Post-care or sub-acute care units. These may be medical-looking, because patients are here for follow-up care from hospitals. Residents are now well enough to leave the hospital but too sick to be cared for at home. The medical care in such facilities needs to be sophisticated enough to provide skilled nursing care and/or rehabilitation services.
  • Long-term, skilled nursing/continuing care facilities. These provide care for patients with permanent physical disabilities and/or who are suffering from dementia, both of which require a high staff-to-patient ratio, with professionals highly trained to meet the specific needs of people with physical or cognitive impairment. Medical care in such facilities is important, and so too is the physical environment, which should be safe and quiet.
  • Finally there is a sub-group of patients placed in homes for end-of-life care. Dr. Boockvar recommends asking about how the home provides palliative care for patients who typically have about six or so months to live. The environment should be quiet and respectful.

SIGNS OF QUALITY

Once your relative is in a home, pay attention to signs indicating that the quality of care is good. Dr. Boockvar offered tips on what you should look for:

  • Expect to see all patients treated with respect and a generally caring attitude by all staff members.
  • Your relative should be able to receive attention promptly when he/she needs it, and you, too, should be able to call a staff member and get through quickly or receive a prompt response to your message.
  • Always be alert to whether or not basic physical and medical needs are met — for example, don’t be quick to judge care lacking if your relative is still wearing PJ’s in the afternoon. Don’t assume this is wrong, but find out why… for instance, some patients prefer remaining in bed some days. On the other hand, if you see that he/she is wearing the same bed clothes three days in a row, that’s a sign that proper care is not being given.
  • Unexplained weight loss, pain that is not addressed and pressure sores (bedsores) are all extremely important warnings that something is amiss.

HOME-LIKE ENVIRONMENTS

While many nursing home staffs work diligently to ensure patients’ emotional and physical comfort, for most elderly folks there is still no place like home, says Dr. Boockvar. However, nowadays more facilities are designed to be welcoming, embracing and homelike. In a movement taking place around the country, homes are being built based on the Green House Model (for more on this, see Daily Health News, October 7, 2008) or The Eden Alternative. Generally without additional expense, these homes offer more staff, meaningful activities and greater autonomy to patients, the opportunity to have pets, spend more time out of doors and the like. This is a happy sign of progress in a field where change is difficult to come by because higher quality costs money, says Dr. Boockvar. He also points out that single rooms are a major factor in nursing home satisfaction, but such facilities may be more expensive.

If someone you love requires nursing home care, the most important thing you can do is show up for regular visits. Not only will you cheer your loved one, you will also have the opportunity to monitor for yourself whether the care is good, timely and appropriate. Furthermore, your mere presence will be a constant reminder to staff that this person’s family is involved — and that alone tends to trigger additional attention and care.