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  • Publication # 13-RA012

Before Nursing Home Compare, most nursing home selections were made on accommodation quality, not clinical care quality

Elderly Health/Long-Term Care

The quality of clinical care has not been among the top factors in consumers’ choice of a nursing home for long-term care, whether for themselves or a family member, according to a new study by AHRQ researcher, William D. Spector, Ph.D., and colleagues. Before the Centers for Medicare & Medicaid Services began publishing Nursing Home Compare—an online Federal nursing home report card—in 2002, visits by prospective residents or their families were the primary way consumers collected information to inform their choice. 

The researchers used available data on nursing homes in four States as of 2001 to create their own scorecard of the care quality issues reported in Nursing Home Compare (decline in activities of daily living [ADLs] since admission; pressure sores; physical restraints, hotel quality (number of deficiencies in 42 patient environment quality measures), and other facility characteristics).

Among 4,287 nursing homes in the four States, the percentage of residents with a decline in ADLs ranged from 13.6–14.8 percent, residents with pressure sores from 8.5–10.4 percent, and residents with physical restraints from 7.4–17.9 percent. Regarding hotel services quality, the nursing homes ranged from 1.4–3.4 deficiencies per bed. Most of the nursing homes were for-profit, and the average distance between the chosen home and the individual’s prior residence was 16 to 26 miles across all States. A 1 standard deviation decrease in hotel services quality significantly lowered the nursing home’s odds of being selected (by 20 percent in California, 11 percent in Ohio, 17 percent in New York, and 12 percent in Texas). Yet, none of the measures of clinical care quality were significantly associated with a facility’s probability of choice. 

The strongest predictor of choice for a nursing home was distance (closeness to prior residence), thus allowing continued interaction with friends and relatives. The findings were based on 2001 data on the quality of nursing homes in California, Ohio, New York, and Texas, which did not have their own scorecards at the time.

More details are in "Making difficult decisions: The role of quality of care in choosing a nursing home," by Irena Pesis–Katz, Ph.D., Charles E. Phelps, Ph.D., Helena Temkin–Greener, Ph.D., and others in the May 2013 American Journal of Public Health 103(5), pp. e31-e37. 

Reprints (AHRQ Publication No. 13-R050) are available from AHRQ.


Page last reviewed September 2013
Internet Citation: Before Nursing Home Compare, most nursing home selections were made on accommodation quality, not clinical care quality: Elderly Health/Long-Term Care. September 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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