[H] An elderly person who describes herself as in poor health, therefore, might be no less depressed in assisted living (even if her children preferred it) than in a nursing home. A person who bad input into where he would move and has had time to adapt to it might do as well in a nursing home as in a small residential care home, other factors being equal. It is an interaction between the person and the place, not the sort of place in itself, that leads to better or worse experiences. “You can’t just say, ‘Let’s put this person in a residential care home instead of a nursing home—she will be much better off,” Dr. Robison said. What matters, she added, “is a combination of what people bring in with them, and what they find there.”
[I] Such findings, which run counter to common sense, have suced before. In a multi-state study of assisted living, for instance, University of North Carolina researchers found that a host of variables—the facility’s type, size or age; whether a chain owned it; how attractive the neiorhood was—had no significant relationship to how the residents fared in terms of illness, mental decline, hospitalizations or mortality. What mattered most was the residents’ physical health and mental status. What people were like when they came in had greater consequence than what happened one they were there.
[J] As I was considering all this, a press release from a respected research firm crossed my desk, announcing that the five-star rating system that Medicare developed in 2008 to help families compare nursing home quality also has little relationship to how satisfied its residents or their family members are. As a matter of fact, consumers expressed higher satisfaction with the one-star facilities, the lowest rated, than with the five-star ones. (More on this study and the star ratings will appear in a subsequent post.)
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