Tuesday, September 30, 2008

An alarming statistic and ranking results

Violations Reported at 94% of Nursing Homes

About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.

The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.

...In December, the Bush administration plans to begin using a five-star system to describe the overall quality of care. The best homes will get five stars. The rankings will be published on a federal Web site.*

New York Times, Sept 29, 2008

Americans persist in saying that they have "the best health-care system in the world". It is certainly the most expensive. (Where is there another more expensive system?) Most international studies repeat that it is not "the best". In a Disney-esque way, I can say that there is a happy ending. We should hear more results about federal health and safety standards in American nursing homes December when the federal government publishes a five-star ranking system. But is this a "happy ending"?

It is important for nursing home shoppers to note that for-profit nursing homes had more deficiencies than nonprofit homes! Should be an interesting result, if they measure wide-ranging issues, such as medication mix-ups, poor nutrition, and abuse and neglect of patients.

Americans do love to lead the world with measuring tests: driver's licenses (before you drive over someone), auto inspections (to tell you whether your car needs fixing), house (occupancy worthy) and restaurant inspections, private school entry tests(SSAT), university entry tests(SAT), and exams and rankings of public school teachers, universities and graduate schools, professional schools and memberships, and so on.

There is huge interest in testing others here that has created lots of employment in probably the most competitive society anywhere. America has institutionalized testing. But I do not believe that the rankings are always correct and accurate. Testing does not always reflect true learning and knowledge. At the same time, what better measures do we have?

Sometimes a lighter system of measure, or frequent lighter testing, rather than heavy one-time testing and certification, like using honey to attract flies, is more encouraging and over time promotes superior results. For example, shopping venues have varying levels of service and price where your expectations are set from the moment of entry. That is fine.

This ranking of nursing homes could improve them by rating them like hotels and restaurants (which can improve if monitored and tested). This improvement, keeping an eye on the results, lies at the heart of the benefits of testing, as well as publicizing the results to help consumer end users make better choices and decisions. But at worst, rankings, generally, can destroy jobs and careers unnecessarily and unfairly.

Thoughtfulness and experience must balance and sometimes overthrow ranking results that prove to be erroneous, inaccurate, unsuitable and questionably motivated.

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