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2002

New Web Site Helps Californians Choose a Quality Nursing Home

Research finds widespread quality problems

October 15, 2002

With the launch today of California Nursing Home Search, Californians have more information to choose a quality nursing home than residents in any other state. Developed by the California HealthCare Foundation (CHCF), the Web site (www.calnhs.org) offers detailed information on each of the state's 1,406 nursing homes, including how the home rates on measures experts say are important to quality of care and quality of life.

"At any given time, more than 100,000 Californians reside in a nursing home," said Mark D. Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation. "They are spending $5.6 billion a year on care. But until now, little or no objective information has been available to help people choose a nursing home based on quality. This is the richest source of nursing home information ever generated for one state."

The Web site provides detailed information on all of the primary quality factors experts say should be considered in selecting a nursing home: staffing levels, clinical performance measures, complaint and deficiency ratings, staff wages, and percent of total expenditures spent on care. In addition, www.calnhs.org rates facilities as better than average, average, or worse than average for being able to prevent or treat three conditions — weight loss, being in bed all or most of the time, and use of physical restraints.

"California Nursing Home Search is a one-stop shop to help people easily compare the quality of care homes provide," said Ann Monroe, director of the California HealthCare Foundation's Quality Initiative. "In addition to helping consumers, the site gives regulators, the nursing home industry, and advocates data they need to make improvements and track progress."

Development of California Nursing Home Search began in February 2000 when the California HealthCare Foundation funded a $2 million project to evaluate the quality of the state's nursing homes and make the findings available to the public. Charlene Harrington, Ph.D., School of Nursing, University of California, San Francisco, led a team of researchers from the University of California Los Angeles, RAND, and the University of Wisconsin who compiled publicly reported state and federal data on nursing homes, analyzed the information, and validated the findings.

"There is a wide range of quality among the state's nursing homes, and even within a single home for different aspects of care," Harrington said. "We encourage people to give quality indicators as much or more weight than convenient location, price, and the recommendations of friends." Nurse staffing levels are particularly important to quality of care, she said.

While the main goal of the project was to create an information resource on individual nursing homes for consumers and health care providers, the data analysis revealed a number of findings about the overall quality of homes in the state. The extensive study of the state's nursing facilities found that while nursing home beds are available in nearly all parts of California:

• Forty-four percent of the 1,212 nursing homes reporting data for 2000-2001 did not meet the minimum nurse staffing level requirements. Nursing levels affect quality of care such as feeding assistance, helping residents get out of bed, and incontinence care.
• Twenty-three percent of nursing homes are in full or substantial compliance with federal regulations. Another 15 percent had very serious deficiencies that actually caused or had the potential to cause serious harm, immediate jeopardy, or death to residents. The remaining 62 percent of homes did not meet the federal standards for substantial compliance but had deficiencies that, while serious, were considered less harmful.
• There are problems with quality of care in most nursing homes and in most of the clinical areas reviewed, such as preventing or reducing weight loss, being in bed all or most of the time, the use of physical restraints, pressure ulcers (bed sores), incontinence, loss of physical functioning, and depression.
• Staff turnover rates are very high. The average nurse staff turnover rate was 78 percent in 2000-2001, ranging from 4 percent to 296 percent.

• Location: by zip code, city, and county;
• Size of home;
• Type of services, including specialized services such as care for Alzheimer's, physical disabilities, etc.;
• Type of payment accepted (Medicare, Medi-Cal, or self-pay);
• Type of residents who live there;
• Whether nurse staffing levels meets state requirements;
• Publicly reported complaints and deficiencies;
• How the facility rates on measures that experts say are important to quality of care and quality of life;
• Type of ownership; and
• Cost per day and financial indicators about the facility.

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