Can We Rate Nursing Homes Like Restaurants?

My mother offered an example of the weight loss dilemma. She went into the center over-weight and rapidly lost excess fluid when she was put on a healthier diet. This was good for her severe arthritis, which is the main reason she was in the home. She fell at least once a week in her apartment home, so she needed to have care around the clock. Dad was in Rosewood, so she chose to move there, too.

As mom developed dementia, and cancer spread through her system, she got so she couldn't eat. I discussed with her, and with staff, just how much "encouragement" they should give her to eat. I know first hand what it's like to be to told to eat, when I can't. I was a little kid who couldn't eat a lot at once, living in a world of hearty appetites. I'm still that way. I'm a grazer. Give me a lot of food, and I'll pick at it and soon be full. I can't eat more. But in an hour, I'll be ready to eat again. It's the way I'm put together. So, I understood when Mom said she couldn't eat.

We pushed fluids as much as possible and I brought her favorite foods for her including fresh fruit, and shrimp and dipping sauce. But still, she lost weight. This made the home look bad on the surveys. However, it was not neglect. The staff went out of their way to make her toast and other things she wanted if she couldn't eat the full meal. They did all they could.

As an aside, this home and many others have taken another giant step toward patient-centered care and now offer several meals a day, at the resident's choosing. Mom would have liked that better. However, the staff at Rosewood was so good to her, that they essentially did the same thing, even when it wasn't "procedure." Still, they looked "bad" on the books because of her continual weight loss.

My point is this. Inspection is necessary. Maybe even a 5 Star ranking system is okay, though it seems like a simplistic bandaid slapped over a multilayered sore. It seems to me that it's more of a political move than a real effort to uncover bad care facilities. Nursing homes are about people. They are about staff. They are about individuals. And the quality of a home is going to go much deeper than a five star rating system.

Families still need to tour homes. I advise dropping in at a home your are interested in during different times of the day and evening. I also tell people to look at how the lowest level employees at the care center are treated by the upper level employees. That will tell you far more about the quality of a nursing home than how many stars it gets during a once a year inspection.

The administrator of one local home in my area was once a nurse. He knows every resident by name. He wears street clothes and is out in the hall or in resident's rooms more than he is in his office. And he's not afraid to wipe a runny nose or drippy chin. Where would this kind of care show up on a five star rating system?

Nursing homes aren't restaurants. They are care centers. They have many more layers to sift through than a mere "5 star" ranking will allow. I'm not saying this system is totally bad - I'm just saying it may lead people to believe that just because a center has five stars, it is the best. There could be one with 4 stars that has a more compassionate, stable staff.