The Consumer Reports Nursing Home Quality Monitor, formerly known as the Consumer Reports Watch List, identifies nursing homes that are likely to provide better-quality care and those likely to provide poorer-quality care. To make those judgments, we looked at three dimensions of quality:

• Deficiencies cited in each nursing home's three most recent state inspection surveys. We examined only specific quality-of-care deficiencies--those given for substandard quality of care, those given for putting residents in immediate jeopardy or causing actual harm, and those given for failing to make the state inspection survey readily accessible to nursing-home residents and their families. We also looked at total deficiencies. We reviewed the results of the three most recent surveys to get a complete picture of nursing-home compliance with federal regulations. It is not uncommon for facilities to improve and then go bad again, so our evaluation was based on more than one survey.

To develop a single score for each nursing home, different types of deficiencies received different weights, which reflected our professional judgment about the relative importance of each factor. We then summed the weights for all deficiencies. We also weighted the deficiencies according to how recent they were. For example, a home's score on its most recent survey was given more weight, and the least weight was given to the oldest survey.

All nursing homes in a state were then ranked according to their aggregate deficiency score. Homes whose score placed them in the bottom 10 percent of all homes in the state were identified as potentially poorly performing homes. Homes whose score placed them in the top 10 percent were identified as providing potentially higher-quality care.

• Staffing levels. We obtained data for three types of nursing staff--RNs, LPNs/LVNs, and nurse's aides. To develop a single staffing score for each home, we developed a weighted sum of nursing hours. The staffing at each home was measured in hours of nurse staffing per resident day. Again, the weights reflected our professional judgment about the importance of each type of nursing care. The more current the data for staff hours, the greater the weight.
  
  
• Quality indicators. Nursing homes are now required to report to the CMS certain quality indicators. These give some clues to how well a facility is caring for patients. For our Quality Monitor we used the following indicators: the proportion of residents in the home who were at high risk for pressure ulcers and who had a pressure ulcer; the proportion of residents who spent most of their time in bed; the proportion of residents who experienced a decline in their ability to move about independently; the proportion of residents who were at low risk for incontinence but became incontinent; and the proportion of residents who declined in the activities of daily living between the two most recent assessments available to the Centers for Medicare & Medicaid Services (CMS).

We then summed those percentages to create a single indicator score for these five quality indicators.

Developing our summary for each home

Within each state, homes were scored on each dimension of quality. For each dimension, we identified those homes that scored in the best 10 percent and those that scored in the worst 10 percent in each state. To land a spot on our list of potentially good homes, a facility had to be in the best 10 percent on at least two of our three dimensions of quality. To be on the list of potentially poorer-performing homes, a facility had to be in the lowest 10 percent on at least two of the three dimensions.


HOW TO USE THE QUALITY MONITOR

If you need to find a nursing home for a family member, look first to the potentially good facilities in your area and avoid those on the potentially bad list. Particularly worthy of consideration are any good homes close enough that you can visit often. Having a relative in a facility near you is important, and visiting frequently helps ensure better care. The staff knows which family members visit and which ones are involved in the care planning.

Consider our Quality Monitor the beginning of your search. You will still need to follow other steps to be sure that you are getting a good facility.

If your relative is already living in a home on our list of potentially bad facilities, you need to be extra vigilant. Visit often, make sure the care plan is being followed, and speak up when care is poor. You may have to involve the local long-term-care ombudsman or the state regulatory agency. Of course, you have the option of moving your relative, but this should not be done lightly. Transferring residents to a new facility is often traumatic and disruptive. If you choose to do this, seek the advice of your family member's physician and other care professionals.