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The Honolulu Advertiser
Posted on: Monday, December 22, 2008

Nursing home ratings not perfect, but a good step

A new five-star rating system attempts to give families a new tool to ease what's often a difficult, heart-wrenching task: choosing the right nursing home for a loved one.

It's a development with good intentions — boiling down vast reams of evaluative information into an easy-to-use ranking, like a Zagat survey of restaurants.

A tool that makes it simpler for people to compare nursing homes — which can vary widely in overall quality — is welcomed. And if it can prod low-ranking homes to improve their care to get a higher score, so much the better.

Overall, Hawai'i fared pretty well. We ranked fifth among the states with the percentage of nursing homes — 23.9 percent — earning the maximum five stars.

But nursing homes are not restaurants, and the system has limitations that Hawai'i consumers should consider.

The ratings are based on three major criteria: staffing levels, state health inspections and quality of care, which includes 10 national measures, such as how well the home prevents and treats bed sores.

But some of the data, like staffing levels, are self-reported once a year and may not reflect current conditions.

Also, since the ratings are based on three years' worth of data, it may not fully reflect recent improvements made by a nursing home.

There is no substitute for actually visiting the nursing home to decide if it's suitable. And, unfortunately, Hawai'i has a critical shortage of nursing home beds: Too often, what's suitable means simply what's available.

Even so, the rankings Web site (www.medicare.gov/NHCompare) presents detailed criteria that can help the consumer ask the right questions when checking out a nursing home.

For instance: How much exercise do residents get? How many are given influenza or pneumococcal vaccinations? Is there a program to prevent the spread of infections? How much time does the nursing staff spend with patients?

The long-term care of Hawai'i's kupuna will become a bigger issue in the future, as more of the population gets older and in need of more intensive care.

Certainly, efforts to put more state and federal funding into at-home care — so-called "aging in place" — should be a priority. It can be more cost-effective, more comfortable for the kupuna and help open up nursing home beds for those who really need that higher level of care.

Making sure Hawai'i's nursing homes offer the highest quality care possible is a joint responsibility — the government, the industry and consumers all have a role to play.

The rating system, while not perfect, provides a useful measure of how we're doing and more important, how we can improve.