Column: Nursing home nightmare

Choosing a nursing home for a loved one is no easy task. A few years ago, I was pretty desperate to find just the right place for my late wife, as she fell deep into the clutches of Alzheimer’s Disease.

We have a federal database (the Nursing Home Compare Database) that is supposed to help us in choosing a nursing home for our loved one. This can be found at: www.medicare.gov/NHCompare.

I thought it was a great help in my search. There are good facilities in our area, and I visited perhaps a dozen of them, making a careful inspection of each, before finally deciding on one that seemed just right. Doing the “Goldilocks” thing — even checking out the beds — is what you have to do.

And it was a good choice, but today I feel that my good choice was just plain blind luck. I realized, on reading an editorial in the Boston Globe, that I could easily have made a really bad choice.

In its April 27 piece entitled, “Enforce Quality Care for Elders,” the Globe points out that the Department of Health and Human Services (DHHS) is failing in its duty to make sure that nursing homes correct their shortcomings and then continue to meet quality standards. That is the conclusion of an April 23 report Congress mandated from the Government Accountability Office (GAO). Here’s a quote from that report, referring to the Centers for Medicare and Medicaid Services (CMS):

“In general, the effectiveness of CMS's management of nursing home enforcement is hampered by the overall complexity of its immediate sanctions policy, intended to deter repeated noncompliance, and by its fragmented data systems and incomplete national reporting capabilities.”

I think they mean that they made the rules too tough, or too hard for the non-compliers to understand. And as we’ll see, the government and the state inspectors from the 50 states are not on the same page. You’ll find this report at: www.gao.gov/htext/d07241.html.

According to the Globe, the U.S. has more than 16,000 nursing homes, caring on an average day for about 1.5 million patients. Most of these are elders, of course, and most are on Medicaid or Medicare, monitored by the DSS, with reporting from the public health department of each state.

Let’s go back in time to another report that Congress mandated. This one is dated Feb. 21, 2002 — more than five years ago — and it begins: “HHS Nursing Home Compare Website Has Major Flaws.”

Wait a minute! Five years ago it was reported to have flaws. Nobody told me about that. Did they tell you? And now we find out it still has the flaws?

This one, prepared for Rep. Henry A. Waxman and Sen. Charles E. Grassley of the Committee on Government Reform, said: “The report finds that ‘Nursing Home Compare’ has major flaws that can mislead families seeking to find a safe nursing home.” Heck! Why didn’t Hank or Chuck tell me?

Here’s what they’re still not telling us: the data on ‘Nursing Home Compare’ does not include tens of thousands of recent violations of federal health standards, including nearly 60 percent of the violations involving death or serious injury.

While you’re reading this, the Nursing Home Compare Web site is being used by a lot of people. Millions of families turn to it. The Web site receives approximately 100,000 visits a month and is one of the most popular destinations for individuals who view the Medicare homepage. HHS says, “the most important information on this site is the searchable database that allows the public to determine the compliance status of virtually any nursing home in the United States.”

Despite this talk of compliance, the report shows that the HHS Web site in fact excludes information on many documented health violations in these nursing homes. Information is missing because Nursing Home Compare does not include the results of complaint investigations conducted by state inspectors.

You can read the whole thing. Just search on: “Nursing Home Compare Website Has Major Flaws.” Won’t somebody tell me it’s just a bad dream?