Odd how the dust settles, as moving day reminds us

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor
When you move workspaces, there are endless unexpected discoveries. Some depress, some thrill, some just boggle the mind.

The last category is how I characterize what I found in a sheaf of yellowing newspapers while packing boxes for our recent office move. Has it really been 10 years since the Department of Health and Human Services first started publishing data so consumers could compare the nation's nursing homes?

The widespread angst of how this might damage nursing home operators is as vivid in my mind as if it had happened last year.

Residents in pilot states such as Florida and Ohio started seeing full-page newspaper ads from HHS on April 25, 2002. They listed dozens upon dozens of facilities and their corresponding percentages of residents with pressure sores, pain, or loss of ability in basic daily tasks. The national rollout came nearly six months later, on Nov. 13. It's a date that might live in infamy in some providers' minds.

The funny thing is, when the feds printed the numbers, no one really knew what to make of them. If 8% was the state average for pressure sores and facilities ranged from 3% to 29%, just what did that mean? The public was, in a word, unfazed. Uncle Sam had given them a big new phone book but didn't — and couldn't — tell them what the numbers said. Were there a lot of pressure ulcers because a facility admitted sicker residents? Was it a wound-care specialist? Did it have a lousy referring hospital nearby?

Since then, however, regulators have fine-tuned their efforts, numerous times. Just this year alone, there have been additions or upgrades to the information published about inspection results, antipsychotics usage, staffing and quality measures.

The Nursing Home Compare website, where this data resides, also has been overhauled, several times. And, of course, we now have the Five-Star Rating system, which has been pilloried by providers, and tweaked by responsive regulators. The system has been embraced (including by hospital discharge planners) more readily than anyone on the regulatory side might have hoped.

The cautionary conclusion of this is that even a weak seed, once planted, can grow into something that eventually dominates your garden plot — for better or worse.

And it makes you wonder just what things might be like 10 years from now.
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