November 6, 2018 / 7:34 PM / 10 days ago

Nursing home safety data hard to find

(Reuters Health) - Nursing Home Compare, a web-based tool from the U.S. government that helps consumers look into the quality of nursing homes, falls short when it comes to rating safety, a new study suggests.

Nursing Home Compare, on the Medicare.gov web site, lets users find and compare nursing homes certified by the U.S. Centers for Medicare and Medicaid Services (CMS). (bit.ly/2GhedTA ) The tool does consider some measures of patient safety, but safety doesn't seem to factor much into the site's rating system and details can be difficult for consumers to dig out, researchers say in a report in Health Affairs.

“Nursing Home Compare has been helping consumers choose nursing homes for around two decades,” said the study’s senior author, R. Tamara Konetzka of the University of Chicago. “Some standard patient safety measures - falls, UTIs, and pressure sores - are indeed on NHC,” she said. “However, they don’t play a large role in determining the overall star levels, which is why we say that NHC does not reflect patient safety well. Most consumers just look at the star levels, which does not give them much information about patient safety.”

The information on Nursing Home Compare comes from three key sources: the CMS health inspection database, a national database of resident clinical data known as the Minimum Data Set, and Medicare claims data.

While it wasn’t hard for Konetzka and colleagues to find information on such safety issues as bed sores, urinary tract infections and falls, medication errors were another story. “If you’re interested in avoiding a place with a lot of medication errors and want to know which nursing homes did well on that, you’d have to dig deep, get into the actual inspection reports and know what you’re looking for,” Konetzka said. “It’s a level of depth I don’t think many would know how to do.”

The researchers analyzed data on all 15,652 nursing homes in the U.S. that are certified by Medicare, Medicaid, or both. Along with information from Nursing Home Compare, the researchers looked at data from Certification and Survey Provider Enhanced Reporting (CASPER) for the first quarter of 2017.

CASPER is a compilation of data collected by surveyors during regular inspections of nursing facilities for Medicare and Medicaid certification. From CASPER, the researchers obtained profit status, payer mix, chain status and whether the nursing home had been cited for medication errors in its most recent health inspection.

At the extremes, Konetzka said, there did seem to be some correlation between safety issues and a nursing home’s star rating, albeit a weak one, but that wasn’t true for the mid ranges: two stars to four stars.

The current system “leaves families sort of flying blind,” said Dr. Albert Wu, an internist and professor of health policy & management at the Johns Hopkins Bloomberg School of Public Health in Baltimore. While factors “such as staffing ratio are important, this isn’t really telling me anything about safety. And I think one of the main reasons people decide they need to move a loved one to a nursing home is it’s no longer feasible or safe for them to be cared for at home. So certainly one of the first things you want to know is, is this going to be a safe place.”

Many of the questions people typically have about nursing homes aren’t addressed by the Nursing Home Compare system, said Wu, who was not involved in the new research. “Most important is, would I want to live here,” he added. “And then, are the residents happy and alert? Are there activities for the residents? Does the facility look and smell clean? What are the interactions between staff and residents like?”

“All of that information could be captured in a nursing home’s rating,” Wu said.

While the current version of Nursing Home Compare is a good first step, Wu said, “much more is needed to provide people with the information they want and need.”

SOURCE: bit.ly/2F7adbS Health Affairs, online November 5, 2018.

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