Die young, people. Ever been to one of these? It's like a waking nightmare.

Wait-50% of all nursing homes are below average by definition, right? Is it that much of a stretch to assume about a quarter are well below average?

And in other news, 50% of nursing homes are below average.

@Coles_Law: Yes, but only because 54% of all statistics are made up.

@Vandon: nearly 50% are above average!

/cup half full

@ADismalScience:

I hope I die before I'm put into one. If I'm not dead, I'll go for senile.

@Vandon: ...and then she eats it!

/2 girls 1 cup completely full

And while the heads of bankrupt corporations receive multimillion dollar bonuses, the assistants in the nursing homes - the one with the most day to day contact with your loved ones, make less than a barista at Starbucks.

The problem is that most of these homes are owned by private organizations who would rather turn a profit then properly care for people. Same reason that there's so many horror stories about insane asylums.

My grand parents were lucky and got into a place that offered specialized care and thus was very well handled. With more general facilities, though, its a risk.

OMG, OMG! I have worked in a nursing home/skilled nursing facility for 5 years. Here are some facts for you:
1. CMS and State Surveyors do not take into account clinical outcomes when making assessments.
2. Surveyors often have double-standards, meaning if you have a good reputation, they try harder and hold you to account for things they let (according to reputation) sub-standard nursing homes get away with.
3. If you are fined by the feds, the state fines you double for the same thing (at least in WI).
4. Nursing homes have an expectant profit margin of about 1%. Even so it costs between 5K and 8K a month for a resident.
5. If a Doctor examines and determines you did everything possible to prevent at injury you may still be fined.
6. Sippy cups and sectional dishes are considered restraints.
7. CMS now wants to consider fall alarms and pressure sensors restraints, and nursing homes cannot use restraints (at least not in WI).
8. If a surveyor makes a mistake and even if you can prove it legally, they will not reverse a decision if it was for a major fine.
9. Nuclear power plants literally have less regulation than nursing homes.
10. Hospitals are held to lower standards than nursing homes.
11. A bib is not a bib, it is a clothing protector and you must ask every patient if they would like one no matter how demented they might be (which can lead to changing a resident's clothes 3 times a day).

There is a lot more I could rant about concerning medicaid reimbursment for transportation and how patronizing surveyors can be before they screw you but I'm out of time.

easy solution - move them all to Lake Woebegon, where everybody and everything is above average.

Our genetic inability to understand probability dooms us...

@Coles_Law:

50 percent are below the MEDIAN, not the mean (AKA average).

Regardless, the only way for there to not be below-average anythings is for no one to excel. (But none actually have to be "much below average")

"Average" should not be the word they use in this ranking. It's misleading. The survey isn't comparing homes to each other, so it's really a "meets expectations" categorization. There's no reason half of nursing homes should be expected to fall "below average" in this list, in other words.

Yes, "average" is a very bad word to use for this...

From what I've been told from my wife who used to be a CNA in a nursing home and a few friends who are or who have been, it's a horrible job. NOT because the work sucks (if you're the type that likes taking care of people, then you like the work), but that management treats the workers like shit.

My wife went BACK to work at WALMART after being a CNA because Wal-Mart treated her MUCH better as an employee than the two different nursing homes she worked at.

You treat your employees like shit, they do shitty work, no matter what. If only all managers/bosses realized this.

@chriswalters. they do mean to use average. check out methodology - they speak in terms of variance from a mean, and the data roughly fit a normal distribution.

the Nursing Home Compare site sets out to use the concepts of mean and variance, and then acts surprised when some nursing homes fall into the lowest quartile. It's like using a hammer and acting surprised when the thing you're hitting breaks.

Average? Of course some fell below the average. DUH, what is the definition of average?

Below acceptable standards? Unfortunately, yes, some nursing homes are below acceptable standards.

Any solution? Besides closing all nursing homes and trying to care for our elderly in our own homes?

Pressure sensors and fall alarms are restraints just not physical restraits I've worked in ALFs and these things can really make peoples lives hell best leave it up to a Doctor to prescribe not some pissy CNA @Persistence:

@Persistence:
Get real.
#9 is flat out wrong & totally ridiculous!
For example: no nursing home has to have plumbing that exceeds specific metallurgical specifications other than meeting the local plumbing code.
Nuclear plants do.
Nuclear plants have to have security fences & armed guards. The last nursing home I went to, all I did was ask at the front counter for a resident's room number & walked to it.

Nursing homes also don't have a federal government department specifically aimed at regulating them; The Nuclear Regulatory Commission. [CMS covers lots more than nursing homes, it runs Medicare & Medicaid, much of whose costs are in hospitals]

#4 is also wrong, just look at all the millionaires that own nursing homes.

@Adisharr: This came out while I was visiting my father, whose retirement community includes a continuing care facility that got 5 stars (top 12%) in the survey. He's been in that part of it when he's had pneumonia. If I could afford it, I'd totally sign up. The good ones really are good.

@aaron8301: Which is why I suspect my dad's isn't the only five-star one that treats its employees quite well--onsite day care, tuition reimbursement, etc. People study their way up the ladder, and staff turnover is low.

@Persistence:

"6. Sippy cups and sectional dishes are considered restraints."

WTF?!?

With my luck, I'll end up in one like the one in "Bubba Ho-Tep."

@HogwartsAlum: I think that's a misunderstanding. Neither CMS, HCFA, or FDA guidelines say any such thing, and I'm pretty sure they use sippy cups when necessary at my dad's place, and they were categorized as having 0% patients subject to restraints.

There are devices that could fall under the HCFA's heading of restraint if they're keeping a patient from being able to move voluntarily--tray tables, for instance, or even tight sheets. But I don't see how that could stretch to a sippy cup.

@Canino:

you know, saying stuff like this should be an insta-ban nowadays.

@Greasy Thumb Guzik: If you look at the sheer Number of regulations regarding nursing homes vs. Nuclear power plants you will find that it is FACT that nursing homes have a larger number of regulations.

My gf was a nurse for 16 years where I currently work and left to work in a hospital because the amount of paperwork regarding patients was so overwhelming that she often did not get to meet her rehab patients before they left. Disgusted by the inability to have direct contact with her patients she went to work in a hospital where, in a non-administrative job, she gets much more satisfaction and much higher pay.

The simple fact is that many policy-makers can't let go of the nursing home stigma from decades ago and also, really really hate the amount of money put in to Medicare and Medicaid and want it to go away, so they want nursing homes go away, so they increase regulations every year. Two years ago CMS decided they were going to update ALL regulations. Initially they wanted to do it all at once but realized that no nursing home could implement all the changes that quickly and stay open so they spread it over 5 years, which is still ridiculous (if you take into consideration that they don't expect car makers to have 20mpg fuel efficiency until 2020) and extremely expensive. I work in a facility that's 5 years old and you wouldn't believe the acrobatics we have to perform to keep up with demand, and we still have incredible clinical outcomes and customer satisfaction while paying hundreds of thousands of dollars in fines. We're still in the red from the initial building costs and we just came out of the red from operating costs. That lasted 8 months and now our operating costs are back in the red because of fines. I can't stress enough that we provide high-quality care and while our customers respect us, the state and feds do not.

@floraposte: Until you have a dietitians order for a sippy cup, even if the patient needs it, you can now be fined for using a restraint. I'm not making up the speed at which regulations are changing. This item was brought to light to out dietary coordinator a month ago at an in-service. If you think lawyers are good at bending laws to their will, you haven't been through a nursing home survey.

@Greasy Thumb Guzik: I don't know any millionaires that own nursing homes unless they are "for profit". Where I work is not. If you take my estimate of 5-8k a month and double it, then yes, you could make a profit at a nursing home and it wouldn't be a 1% profit either. I work for a corporation that makes a LOT of money but little profit and the two nursing homes that operate within the multi-hospital system are it's greatest liabilities. Think about this, there have been CEO's that have been fired for letting the profit margin of their company drop below 30%. One percent, that magic "not-for-profit" number, is a fine line.

@Persistence: I'm not clear--who are you saying stated this? I guess I can kind of see it as an interpretation of HFCA/CMS--if it's not medically mandated, then there's the risk of its being a restriction for the staff's benefit--but I'm not finding any instance of an actual fine for it.

Ditto the misleading headline. Average being 50%, 25% is half of that, therefore "much below average." Statistically speaking, to be expected.

I'll take an overpass or the middle of a wilderness over a care facility when I get old, thank you.

I am not surprised by these statistics at all...if anything I'm surprised that they're not worse. I'm an EMT and I work for a company that mainly does interfacility transports - mostly hospitals to nursing homes. The majority the of nursing homes and rehab centers that I go to are horrifying, dismal places. I've ended more shifts than I care to say crying in the back of my ambulance after yet another patient grabbed my hand as I was leaving and begged me not to leave him/her there.

Note that I said the majority. There are a few really nice places that are well-lit, in good repair, and staffed by friendly and professional caregivers who provide daily activities for the residents...but if you think that's the norm, you're kidding yourself.

@TechnoDestructo: The word average can refer to the mean or the median. In fact, it more commonly refers to the mean.

Well hey, maybe with the economy, more people will be taking jobs at these places and they won't be so understaffed?

Surveyors often have double-standards, meaning if you have a good reputation, they try harder and hold you to account for things they let (according to reputation) sub-standard nursing homes get away with.

@Persistence: So I guess the good ones are very good but the bad ones are worse than what's reported.

I saw a help wanted ad in the paper for a nursing home...it paid a whopping $7.40 an hour. To start, maybe they should think about paying their workers enough to give a damn about the conditions of the nursing home.

That's not surprising. I've been a geriatric nurses, and have been working in SNF/Medicare/Assisted facilities for ten years.

State surveys are kind of jokes. They come in with their list of that years hot button issues, but it's always astounding to me which facilities pass. If you do get tagged for something, you get a chance to fix it. It's not that hard to work around state.

There are ways to do things to get your job done, and there are ways to do things to pass a state inspection. They are not the same.

As has been said, the vast majority of facilities are for profit. That means the least number of nurses and NACs on the floor, the better from a profit margin. Getting privater pay patients is better than Medicaid patients.

Filling rooms takes precedents over current patient load. Who cares if you have three MRSA cases, all on Vanco IV's, a new trach, a hip replacement with massive violent dementia, an ex drug addict with a foot amputee, and a bipolar gal with massive pressure ulcers. Profits demand they take that violent head trauma case too, even though it's impossible to be a good nurse safely and do it right with the current impossible patient load. (That was my last stint on a Medicare hall.)

There are facilities I have worked at, that I wouldn't put my dog in. One place I worked at, I came into an evening shift. By the time I went to pass a gal's 7pm meds, I found she was dead. There weren't enough NAC's, and the ones I had were obvious tweakers. I heard from them the gal died at 9am that morning, and they assumed the funeral home was coming. The previous nurse had just ignored it, and left it unsaid. I put my notice in on the spot.

@Chris Walters: Indeed. It's making people think the results are normal.

My Grandmother just passed away a week ago due to a nurse at her nursing home dropping her and causing injuries she was not able to recover from. Needless to say we are filing a law suit and the lawyer we went to had three other law suits filed that week against the same home. When we put her in this home over a year and a half ago it was rated one of the top and we had family in there daily with my grandma being an advocate for her care. Until nursing homes stop running FOR PROFIT nothing will change. They didn't even report dropping my grandma and we only found out because of the injuries when hospice came in for their daily check. Accidents happen but there is no excuse for dropping someone's loved one and not reporting it and now my grandmother is no longer with us because of it, and that is something that I hope that nurse thinks of every night before she goes to bed.

A recent survey commissioned by Clarity and the EAR Foundation found that 89 percent of seniors fear moving into a nursing home, with the corresponding loss of their independence, contrasted with a mere three percent who cited fear of death. And, apparently, their fears are justified. A recent report issued by the inspector general of the Department of Health and Human Services found that more than 90 percent of nurshing homes were cited for violations of federal health and safety standards. Of these, nearly one in five nursing homes had deficiencies that caused "actual harm or immediate jeopardy' to patients. These problems included infected bedsores, medication mix-ups, poor nutrition, and patient abuse and neglect. For more, I invite you to visit our website at www.greatplacesinc.com.

@floraposte:

I can see the tray table. My laptop tray table occasionally traps me on the couch (!) But a SIPPY CUP?????

A nice little sectioned cafeteria dish? That keeps your peas from rolling into your mashed taties? Oh, the humanity!

@Jenng: I'm really sorry about your grandmother. My condolences to your family.

Unfortunately, nonprofit places aren't reliably superior to for profit places--the worst place near me, for instance, is a nonprofit (and no, I don't mean a government place) that's apparently Pressure Sores R Us. I'd be interested to see some consumer guidelines beyond this kind of survey to assessing a home before you commit to it. It sure sounds like you and your family did everything you could as far as checking the place out and remaining active on behalf of your grandmother, and it seems like there should be enough information out there for that kind of diligence to ensure competence in your selection. Maybe someday...