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Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

Finding a high-quality nursing home for a loved one is a big responsibility.

If you've ever been in that position, you probably wondered why you could find more detailed data on the latest flat-screen TV or fuel-efficient car than on a nursing home in your area.

Useful data are now available that can help you compare your options and assist you in deciding on a nursing home. Starting in January 2009, the Federal Government unveiled a new tool called Nursing Home Compare. You can use this tool to look up nursing homes in your area by name, city, county, State or ZIP code.

The tool provides information on nursing homes that have been approved to take patients insured by Medicare and Medicaid. It assigns ratings to nursing homes based on reviews of how many and what type of staff members they have, how well the homes perform on health inspections, and how they rank on quality measures.

Each nursing home is given a star rating (from 1 to 5) for its performance on each of these three elements. These ratings are then combined into an overall rating.

This new rating system is based on a 20-year-old law that reformed how nursing homes provide care. It also reflects more recent quality improvement efforts led by consumers, health providers, and nursing home experts.

Overall, the new tool gives consumers a snapshot of the care that individual nursing homes provide. It also gives consumers the background to ask more informed questions before they decide on a facility.

I must note, however, that Nursing Home Compare can't answer all your questions. It cannot tell how things may have changed—for better or worse—once a nursing home was given its rating.

The best way to get a complete picture of a nursing home is to visit it in person. Ask questions to the people who take care of residents, not just those who work in the front office.

You will be able to ask more informed questions after you review the data that goes into Nursing Home Compare's rating system, including:

  • Health Inspection Results: Major aspects of nursing home care are included in this measure. Trained people conduct the health inspections by visiting each nursing home, checking medical records, and talking to patients. Even though inspection standards are the same from State to State, there are differences in how visits are carried out. That's why it's a good idea to compare nursing homes within the same State to get more accurate information.
  • Staffing Levels: This measure looks at the overall number of staff compared to the number of residents. However, staffing levels are more than just numbers; they also include the percentage of trained nurses and other staff. Nursing homes collect this information once a year, so the data may not always be accurate or current. Keep in mind that quality is generally better in facilities with more staff who work directly with residents. Make sure you ask about how many and what kind of staff a nursing home has.
  • Quality Measures: Ten important elements of quality of care are included in the rating system. They include how well the nursing home prevents and treats bed sores and helps people maintain key living skills, such as eating and dressing. Like the staffing data, these data are reported by the nursing home and are not collected and reported by an independent agency.

To get a fuller picture of the quality of care at a nursing home you may be considering, ask the staff about these elements and about other steps they take to improve residents' care.

The Nursing Home Compare Web site includes a checklist to use when you visit a nursing home. It also provides links to other resources that can help you know what to look for when deciding on a facility. In the near future, the Web site will add a section that gives consumers' perspectives on nursing home quality of care.

As we get more data to help us make decisions about nursing home quality, it's up to us to put that information to good use. Data alone aren't enough to arrive at decision, but they are a step in the right direction. A personal visit at which you ask informed questions builds on this foundation.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

Department of Health and Human Services
Center for Medicare & Medicaid Services
Nursing Home Compare

Center for Medicare & Medicaid Services
Guide to Choosing a Nursing Home

Page last reviewed February 2009
Internet Citation: New Web Tool Helps You Choose a Nursing Home. February 2009. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


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