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Ratings not whole ranking when it comes to nursing homes

Dear Readers: Many of you read the recent articles about the new Medicare ranking system for nursing homes. I'm sure some of you were surprised and even upset by local ratings.

For years, there have been private Web sites that have compared nursing homes, most using the county or state Web sites as a resource. I've shaken my head in wonder, as I know many of our local nursing homes well and often they didn't look nearly as good as they are, if people only went by these ratings.

People around the country write to me about nursing homes in their area. The information these people share has shown me that we are blessed with good care centers. I am not saying they are perfect, but most are good, and some are excellent.

So, why did some homes get two or three stars out of five as an average rating?

One reason is that North Dakota and Minnesota have strong requirements for health. That is good. However, conditions that may rank four stars in another state may only make one or two here. The scale doesn't reflect this.

Nursing homes are one of the most regulated industries in the country. That is good. But if an inspector comes on a day when one staff member didn't do something the regulator checks, no matter how inconsequential, it will be held against the home.

What I want to be very clear about is that that new system is only one tool. There are many ways to judge a nursing home. What this tool lacks is a category for family satisfaction. This fact, which I support, was mentioned by one of the nursing home administrators interviewed by The Forum.

My advice on selecting a nursing home is, yes, find out the Medicare rating for the current month by going to nhcompare. Print out the rating, if you'd like, and take it with you when you visit each home. Ask questions. Why did you get a low rating on health? Just exactly what are "quality measures?" Then, if you don't know any families that have had experiences with the home, ask for references. Check those references.

Also, visit unannounced at different times of the day. How do the residents look? Are they reasonably clean? Are they treated with respect? Are efforts made to engage them in living their lives?

Look at how the staff treat one another. Are the all-important CNAs, who give hands-on care, treated with respect by the nurses and administrators? Do people seem to like their jobs?

You want your loved one in a home, not a hospital. Yes, nursing homes, because they are communal, need to be more institutional than a private home. But as much of that institutional feel as possible should fly below the radar.

Sometimes, when the personal needs of an elder are of greatest importance, a regulation may briefly get kicked to the sideline, and a care center could get a ding on their rating. My personal choice is a home that treats every person who lives in the home as an individual. And that is a concept that's hard to chart with five stars.

Bursack is the author of "Minding Our Elders," a support book on family elder care, and maintains a Web site at To view past columns, go to and click on columnists. Readers can reach Bursack at or write her at The Forum, Box 2020, Fargo, ND 58107