By Pamela Nadash, Edward A. Miller, and Jennifer Gaudet Hefele

Leaving loved ones in the care of a nursing home raises a host of fears: that they might suffer abuse at the hands of uncaring staff; that they might be medicated into a stupor; that they will be ignored and neglected. The specter of being trapped in a bad nursing home haunts us all. To avoid bad nursing homes, we need information that enables us to make good choices.

Pamela Nadash

Recently, The Boston Globe revealed that the U.S. Department of Veterans Affairs (VA) had not released data it had tracked over several years on the quality of the 133 nursing homes run by the VA. (Vets also have access to roughly 2,500 community nursing homes that the VA contracts with and about 160 State Veterans Homes.) Information obtained by the Globe indicated nearly half of VA-run nursing homes received the lowest possible score for quality (although scores on overall quality, which includes other dimensions, match national figures). Clearly, this is a story about the quality of nursing homes. But it is really a story about the need for access to good information — presented in ways the average person can understand — about nursing homes more generally.

Consumers need this information, both so they can avoid low-quality nursing homes and to spur nursing homes to do better. Indeed, one way government aims to improve nursing home quality is by publicizing performance data. Since 2002, the Nursing Home Compare website has presented information on various aspects of quality for more than 15,500 community nursing homes, assigning 5 stars to the best nursing homes and 1 to the worst. But until now, the vets in Globe story could not get this kind of information about VA nursing homes.

Edward A. Miller

Even when that kind of information is available, studies show it is not much used; less than a quarter of nursing home placements are guided by Nursing Home Compare. Why? Most likely because most people don’t know it exists, and few medical professionals encourage them to use it. Clearly, improvements are needed. So the solution to the VA’s problem? Don’t just copy the Nursing Home Compare website. Improve on it.

What would improvement look like? First, the site should be better marketed – especially at the point of discharge from a hospital, when consumers need it. It would be user friendly, taking advantage of what we have learned about the kinds of information that people want and how they use it. Specifically, they want information that feels personal, from either people who have lived there themselves or had a loved one who lived there. In addition to hearing how satisfied a resident or family member was with their stay, they want to hear personal stories – like those posted in Yelp or Amazon product reviews. These kinds of stories can help them decide whether a facility is the right fit for their loved one, or alert them to potential issues.

Jennifer Gaudet Hefele

But aren’t Yelp and Amazon riddled with problems? Can consumer ratings and reviews really be trusted? We know sellers sometimes game reviews, prompting both Yelp and Amazon to devise mechanisms for weeding out false reviews. In fact, much is being done to systematically and rigorously integrate consumer ratings and reviews with scientifically derived measures of care quality: for example, a collaboration between Yelp and ProPublica, an independent non-profit news organization, aims to pull in systematic data from the federal government and other sources to supplement Yelp’s narrative reviews and ratings.

Increasingly, healthcare providers are required to release information that helps consumers make better healthcare decisions. Disseminating quality information – including whether patients are satisfied with their experiences — also helps to incentivize quality improvement. However, nursing homes have largely been untouched by this trend. The VA can spearhead more meaningful consumer involvement by developing a leading-edge website that combines important medical, staffing, and inspection information along with consumer ratings and narratives that resonate with end users. Even when veterans have few choices in which nursing home they are placed, consumer, family, community, and VA medical center awareness of quality issues in VA homes can help drive improvements.

Pamela Nadash is an associate professor of gerontology at UMass Boston’s McCormack Graduate School. Miller is a professor and Hefele is an assistant professor in UMass Boston’s Gerontology Department.