Nursing homes provide residential care for patients who need around-the-clock medical attention. The National Center for Health Statistics reports that nearly two-thirds of nursing home residents are over the age of 75, while more than a third are over the age of 85.
About 1.4 million patients reside in more than 15,600 nursing homes in the United States. Most older patients suffer from some degree of cognitive impairment. Other common health problems include diabetes, heart disease, high blood pressure, and depression.
Most older adults and their family members prefer alternatives to nursing home care. Aging at home with the help of caregivers or moving to an assisted-living facility is often the best choice for older adults who do not need constant medical attention. When an older adult’s health condition precludes other options, families must decide which nursing home will be best.
Nursing Home Compare
Families searching for a nursing home can turn to Nursing Home Compare, a rating system offered by the Centers for Medicare and Medicaid Services (CMS). The search tool allows users to find Medicare-certified nursing homes in their area.
Nursing Home Compare rates nursing homes on a five-star system. In addition to providing an overall score, the rating system includes separate ratings for health inspections, staffing, and quality of care.
The Brookings Institution questions the reliability of the CMS ratings. The rating system is heavily dependent on data reported by nursing homes regarding staffing and quality of care. Research by Bookings reveals “a prevalence of exaggerations” that undermine the rating system. A 2018 study found that patient safety ratings were “weak and somewhat inconsistent.”
Studies suggest that some nursing home providers might be gaming the CMS ratings. Some nursing homes report staffing levels at times when all staff are present even when typical staffing levels are lower. Some nursing homes ask patients about their level of pain only after administering pain medications. Less substantial evidence suggests that nursing homes might select healthier patients to elevate their quality-of-care scores, although fears of “cherry picking” patients are partially offset by the reality that nursing homes maximize their profits by filling their beds.
Alternatives to Nursing Home Compare
The studies referenced above suggest that nursing homes might be “teaching to the test.” That is, nursing homes understand the criteria upon which their Nursing Home Compare rating is based and might sacrifice patient satisfaction in other areas to maximize their performance on the factors that the rating system measures.
Yelp is a familiar consumer rating system that does not assign the criteria upon which ratings are based. Yelp reviews are therefore more personal than Nursing Home Compare ratings. Because Yelp ratings reflect the consumer’s overall experience rather than the nursing home’s self-reported data, there can a disconnect between the ratings offered by the two sites. Yelp ratings tend to be significantly lower than Nursing Home Compare ratings.
While the disconnect might be attributed to nursing homes that game the Nursing Home Compare ratings, it may be that Yelp ratings are lower because they reflect patient concerns that the Nursing Home Compare ratings fail to measure. Those concerns might include the friendliness or helpfulness of staff members, the condition and cleanliness of the facility, and whether the nursing home communicates effectively with the patient’s family members.
Yelp is not necessarily a good alternative to Nursing Home Compare. Every nursing home that is eligible for Medicaid payments is included in Nursing Home Compare. Yelp reviews are not always available for specific nursing homes. A nursing home in a less populated area might have few Yelp reviews, if it is reviewed at all. Unreasonably disgruntled patients or family members might easily skew Yelp ratings when a nursing home has few reviews.
Unless and until CMS devises a rating system that includes concerns important to patients that its current rating system fails to measure, patients and their family members may want to search for information from as many sources as they can find. A facility’s Nursing Home Compare score is an important consideration, but Yelp reviews, the local ombudsman assigned to nursing homes, chats with residents during in-person visits can also provide important information about an older adult’s choice of nursing homes.