Friday, 11 May 2018

No Luck Finding the Right Nursing Home? Maybe Yelp Can Help

Nursing Home

Can you really select a top-quality home by reading Yelp reviews?

There’s a home subsequent town over from me, as an example.

Nine reviewers have given the place both laudatory five-star ratings (“She features a far greater quality of life than she would have lived at home”) and outraged one-star complaints (“The nursing staff, RN’s and CNA’s are caring but overworked”).

Overall, the place gets three stars. It’s a highly flawed measurement, of course.

Nine reviewers for a 300-plus-bed facility? Over four years, in an industry known for such sky-high turnover that a lot of the hands-on staff have undoubtedly left since the primary online critic weighed in?

Reviewers can deplore the food, but can their skills often residents fall?

Yet gerontologists at the University of Southern California are looking into Yelp home reviews and think they create a useful addition to the homework any prospective resident or a loved one must undertake.

It’s not that reviews posted on Yelp and other online platforms (Google, Facebook, Caring.com) are such reliable guides to home quality, said Anna Rahman, senior author of a recent article within the Gerontologist.

It’s that the supposed gold standard, the five-star ratings on the federal government’s own Home Compare website remains so faulty.

“We had a growing sense of how disappointing those measures are,” Dr. Rahman said of home Compare.

“After 20 years and every one the cash spent to make it, it’s become a marketing tool. But most people don’t realize how little it measures. It’s garbage in and garbage out.”

A primer: home Compare made its online debut in 1998 and added the starred the ranking system in 2009 after a senator complained at a congressional hearing that it had been easier to buy for a washer than a home.

The site contains a trove of data about nursing homes, for those willing to click through to findings like hours of staff time per resident per day, deficiencies discovered during the foremost recent inspections, and the way many residents have bedsores and other indications of poor care.

This year, the federal Centers for Medicare and Medicaid Services anticipates that the tool is going to be used 2.4 million times.

Those on-site inspections, which Medicare requires every 12 to fifteen months, constitute a key component of the ratings.

But the 2 other categories contributing to the ratings — staffing and quality measures — are reported by the homes themselves.

Critics have charged for years that the metrics are untrustworthy and susceptible to manipulation.

A New York Times investigation in 2014 reported that facilities had learned the way to game the system, leading to rising proportions of four- and five-star nursing homes.

A Brookings Institution report two years later concurred that ratings had become inflated.

“I would never use it for quality measures because I don’t believe it,” said John Schnelle, director of the middle for Quality Aging at Vanderbilt University center. “I think they’re distorted.”

Dr. Schnelle, note, serves on the expert panel that advises C.M.S. on its home scoring system.

Researchers even have discovered that albeit the star ratings were accurate, they don’t bear many relationships with how residents and families feel about these facilities.

In Ohio, which conducts its own statewide home surveys, “plenty of times residents really liked a facility with a coffee star rating and the other way around,” said Robert Applebaum, a gerontologist at Miami University in Ohio.

He has found that families’ and residents’ satisfaction varied significantly at the poles — they did prefer five-star to one-star homes — but the differences in satisfaction between one- and two-star homes, or those with four versus five stars were negligible.

Nursing Home Compare doesn’t include consumer feedback in the least, although a Government Accountability Office report urged C.M.S. to feature this feature.

“It excludes the foremost important element,” Dr. Applebaum said. “The problem is, it’s really expensive to try to to. Collecting data from families and residents is not any small task if you are doing it systematically.”

Enter Yelp, where the primary home review appeared a decade ago, and it is online competitors, including Facebook. Dr. Rahman and her colleagues, watching 51 Yelp-rated nursing homes across California found that the majority reviewers commented on intangibles like staff attitude, caring, and responsiveness; they rarely mentioned health care quality or safety concerns.

So perhaps it’s not surprising that in an earlier study, the team found that consumer rankings on Yelp correlated only weakly to the star ratings on home Compare.

“They’re not measuring an equivalent thing,” Dr. Rahman said. In fact, they rather complement each other.

You wouldn’t want to rely on an excessive amount of on Yelp and other online platforms. 

Relatively few nursing homes assisted living facilities, and retirement communities have Yelp reviews in the least.

The 51 California nursing homes in Dr. Rahman’s study had garnered just five reviews on the average — a small, probably unrepresentative sample.

And the great majority were polarized — either five-star reviews or one star.

“Nursing homes inspire tons of emotion,” Dr. Rahman said.

That the bimodal response isn’t typical in most Yelp categories, but “you’d expect that to normalize overtime” as more users post reviews, said Luther Lowe, the company’s senior vice chairman for public policy.

For now, only 7 percent of Yelp’s roughly 150 million total reviews concern health care: doctors, dentists, hospitals, acupuncturists, and reiki practitioners, alongside assisted living and nursing homes.

Yelp uses software to undertake to comb out fake reviews and sorts roughly one in five into its “not recommended” category, though users can still read them.

Probably its most consumer-friendly move, though, was joining forces in 2015 with the nonprofit investigative news agency ProPublica, which created the tool home Inspect with federal data.

Now, Yelp users see a little ProPublica box reporting each nursing home’s size, what percentage of serious deficiencies showed abreast of its most up-to-date inspections, fines levied, and whether the power is so troubled that C.M.S. has suspended payments.

The box also identifies “special focus” facilities flagged for serious quality problems.

Nursing Home Compare is additionally making changes.

Most importantly, C.M.S. now requires nursing homes to submit timecards quarterly, a more auditable staffing measure than annual self-reporting. “A big improvement,” Dr. Schnelle said.

The bottom line, though, is that each one of these sources has dismaying limitations.

Others could also be even worse: Nursing homes conduct their own consumer satisfaction surveys, but “they say everybody is as happy as are often,” Dr. Schnelle noted.

Online placement services sort of a Place for Mom get paid by the nursing homes they refer people to.

So experts advise starting your investigation online, using Yelp and other consumer reviews — and home Compare and home Inspect, and lecture friends and relatives who’ve had a recent experience with local facilities.

Then, inescapably, you’ve needed to show up at the home, walk around, ask residents and family and staff, ask zillion questions. Then, return and roll in the hay again.

Still, online consumer reviews can become a part of the trouble, and therefore the The more we post, the more useful they’ll become.

“You want to use as many sources as you'll,” Dr. Applebaum said.

“Everybody features a different piece of the elephant to the touch .”

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