Nursing-home comparison tool guides searches on the web

Canadians can now use a web-based tool to check how a nursing home compares with regional, provincial and national averages on measures of safety and quality of care.

The Canadian Institute for Health Information (CIHI) has made public the performance indicators for more than 1,000 nursing homes and other long-term care facilities.

Until now, the information was provided to facilities to track progress.

The information is intended to support comparisons across the country, said Brent Diverty, vice-president of programs with CIHI in Ottawa.

"I think the tool would certainly be one piece of information that may be helpful in considering what home one might select," Diverty said. It "may be a source for some of the questions someone might want to ask the administration in a particular home."

The nine indicators address safety and appropriateness and effectiveness of long-term care:

• Falls in the last 30 days.
• Worsened pressure ulcer.
• Restraint use, which can lead to injury and falls and increase confusion and agitation.
• Potentially inappropriate use of antipsychotics among residents without a diagnosis of psychosis, such as to manage behaviours in those with dementia.
• Improved physical functioning.
• Worsened physical functioning.
• Worsened depressive mood.
• Pain experience.
• Worsened pain.

The information is based on standardized assessments done in part with residents and in consultation with families, Diverty said.

The national rate of daily restraints decreased from 15 per cent in 2010 to less than 10 per cent in 2013 through legislation and changes in practice.

Similarly, use of antipsychotics among those without a diagnosis of psychosis is down from 34 per cent in 2010 to 30 per cent in 2013. Rates were highest in B.C. at 33 per cent in 2013 and lowest in Alberta at 25 per cent.

Candace Chartier, CEO of the Ontario Long Term Care Association, called the information important for caregivers and operators to identify what's going well and where improvements are needed. 

Chartier cautioned against comparing homes directly without fully appreciating residents' acuity, such as their degrees of physical and cognitive decline.

Nursing homes in Quebec, New Brunswick, P.E.I., Nunavut and the Northwest Territories are excluded from CIHI's database. Saskatchewan, Manitoba and Newfoundland and Labrador have data for one regional health authority in each province.

The tool also updates information on hospitals, including new data on time spent in emergency for admitted patients.

Hospitals are grouped together with nursing homes in the database. Only nursing homes with 24-hour nursing care are included and can be searched by name.

Few choices for some

Camille Parent of Peterborough, Ont., keeps a close eye on nursing home inspection reports after a hidden camera captured mistreatment of his 87-year-old mother, Hellen MacDonald, who has dementia. In one portion of the video, a cloth filled with feces was shoved in her face.

"I call these sites smoke and mirrors," said Parent, who advocates to stop elder abuse. "It's just information. They're not acting once they get that information."  

Despite the information that might be available, Parent said, with a shortage of nursing home beds, there's often little choice.