Because we were just discussing the angst-ridden process of selecting a nursing home, I was particularly interested in a new survey from the federal Agency for Healthcare Research and Quality.
If you’re embarked on this task, diligently visiting facilities and hoping you are noticing the right things, don’t you wish you could hear what the staff thinks, particularly the nursing aides who provide the great bulk of hands-on care?
You could ask them, of course. But the recently released Nursing Home Survey on Patient Safety Culture lets us in on what more than 16,000 people who work at 226 nursing homes have to say about where their facilities shine, and where they fall short, on 12 measures.
It’s not a large or representative sample of the nation’s 16,000 or so nursing homes; facilities volunteered to distribute the A.H.R.Q. survey and submit the results. Nonprofit and government nursing homes, it turns out, were more likely to cooperate, so they’re overrepresented: though only about a third of nursing homes are nonprofits, nearly half the homes in this survey are. (Let’s pause here to contemplate why that might be.)
Nor is safety the only consideration in selecting a nursing home or in elder care generally. We tend to overemphasize it, the gerontologist Rosalie Kane has long argued.
The virtue of this survey is that despite those limitations, it lets us metaphorically eavesdrop in a staff lounge or break room where employees — mostly aides and support staff members like housekeepers and maintenance workers, as well as licensed nurses, administrators and managers — are griping and gossiping about their jobs. “It’s an insider’s view,” said Joann Sorra, senior study director at Westat, a private research company, who led the A.R.H.Q. project.
Some of what those insiders say is fairly common knowledge. They’re all too aware that nursing homes are understaffed, for instance. “The big problem seems to be workload,” Dr. Sorra said. Only 41 percent agreed that the facility had enough staff to handle residents’ needs safely, and almost two-thirds agreed that staff had to hurry because there was too much work to do.
Workers also rate nonprofit homes higher than commercial ones, confirming what researchers have reported for years. Eighty percent of workers in nonprofit or government nursing homes would recommend the facility to friends as a safe residence for family members; in commercial homes, 72 percent would. In nonprofits, 66 percent of respondents rated the home “excellent” or “very good” on safety over all, compared with 57 percent in commercial homes — statistically significant differences, Dr. Sorra said.
News to me is that size matters — a lot, though it’s not clear why. In nursing homes with 49 or fewer beds, 77 percent of staff members awarded their facility high safety ratings over all. In facilities with more than 100 beds, only 59 percent did.
So we can throw these findings into the mix as we’re looking for facilities. They’re hardly fail-safe criteria, but it’s useful to know that insiders agree that nonprofits tend to do a better job. And that small is beautiful.
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