Can We Rate Nursing Homes Like Restaurants?

The Federal Government has plans to put into place, by the end of the year, a five-star ranking system for nursing homes. At first blush, this seems like a terrific idea. Families could easily find out the ranking of a home and then make a decision based on the number of stars. Five - great! Four - okay. One - no way.

States and counties already have rating systems for a wide variety of inspections which are done on a regular basis, at least in my area. The results of these inspections are available to the public, so, out of curiosity, I've looked up, on the Web, the ratings of homes I know well. Often, I've been shocked to find that they have "deficiencies."

Home A, I know to be excellent. Here, on the rating page, it has a couple of dings because a patient fell. Home B is also very good, from what I've seen, but they took a hit when an inspector found a couple of residents continued to lose weight.

Then I read the fine print on the inspection site. None of these reports showed neglect or any evidence that the performance of the home caused harm to a resident. None of them showed the home wasn't an excellent facility. Am I glad they are inspected? Absolutely. Do I use these ratings as my only criteria? No way.

I spent so much time at Rosewood On Broadway (where my parents and mother-in-law were) that I was often there when they had drop-in inspections by the state and/or county. Also, there were planned inspections. The home tried very hard to get a perfect rating, and on occasion did. But they knew that the inspectors would nearly always find something. Why? Because they were in the business of caring for human beings.

In my mind, there is a difference between an elder falling due to neglect on the part of staff, and an elder falling due to the staff giving an elder as much independence as possible.

My dad was a good example of this. Restraints are blessedly illegal in my state, and that includes drugs. However, after my dad's brain surgery, he was very unsteady and often forgot he couldn't walk alone. He'd suddenly would get up from his chair and start walking - and then fall.

The staff and I talked it over and they tried putting a tray on his wheelchair, which was legal. We told him it was like having a desk. But even that small amount of restraint caused horrible emotional pain for him. It literally would drive him crazy. We discussed it and agreed they had to take it off.

They did use alarms so that when he got up he'd pull a pin and the alarm would shriek. But he hated those too, as every time he'd roll over in bed, or turn too far in his chair, an alarm would go off. I think he felt a bit like a laboratory rat in training (he was a scientist).

Elders have choices and some of those choices may lead to results such as falls. I'm not saying the care center shouldn't do everything possible to prevent such things, but in the case of my dad, the humane thing to do was give him as much freedom as possible, and risk a fall, as opposed to creating even greater mental agony than he already lived with, from his dementia. The staff and I agreed on this. It was an imperfect option, but life is imperfect.