Discovering a nursing home's track record on quality of care is becoming as easy as a click of the mouse.
Two years ago, Massachusetts began posting on the Internet quality ratings for its nursing homes based on results of unannounced surveys. Other states have followed, most recently Texas, which launched a World Wide Web-based ratings guide to its nursing homes earlier this month.
Now provider groups, which have long argued that survey data tell little about nursing home quality, are getting into the game themselves.
Several post their own consumer-oriented guides, and more provider-sponsored sites are expected to be online in the coming months.
While the industry is debating the relevance of survey data to nursing home quality, there's no doubt that these sites are popular.
The largest online nursing home guide, HCFA's Nursing Home Compare, at www.medicare.gov/
home.asp, gets about 400,000 page views per month.
That site has data on the nation's 17,000 Medicaid- and Medicare-certified nursing homes, including any citations for problems and information on the prevalence of certain medical conditions, such as bed sores, among residents.
Naomi Segal, a senior social worker and placement liaison at 992-bed Thomas Jefferson University Hospital, Philadelphia, says she doesn't need the Web for most of the 1,000 nursing home placements her office does each year.
"Where the Web becomes indispensable is in terms of finding homes for people who are not routine cases," she says.
But the online sites lack some vital information, Segal says.
"They don't tell me the quality of the homes or who's got beds (available), but it gives me a place to start," she says.
Robert Greenwood, spokesman for the American Association of Homes and Services for the Aging, says that survey performance can be misleading.
"It's a good way to get the survey data into the public domain," he says of the online guides. "But there's no substitute for going to visit these organizations."
Segal and independent consumer advocates alike agree.
"The only way you really know what a nursing home is like is to read the survey and visit the facility. Go and smell the place, go and talk to people," says Nida Donar, a program director at the Detroit-based advocacy organization Citizens for Better Care.
Online information is helpful, she says, but could be dangerous if used as the only source in choosing a home.
Though surveys show that only a small percentage of the elderly use the Internet, their numbers are growing. And it's often family members-many of whom are computer-literate baby boomers-who do much of the research for a new home.
Some states, such as Massachusetts, New Jersey, Rhode Island and Texas, post enforcement actions, citation histories and performance records of in-state nursing homes. Other state agencies simply post a listing of homes and let potential residents do their own digging.
Also, in some states provider groups are spearheading the online effort. Predictably, those sites often play down survey results and play up alternate measures of quality.
The Health Care Association of Michigan hits members up for a $4-per-bed fee to pay for an independent agency to poll residents' families on their satisfaction with nursing home services. The HCAM site posts results from that consumer survey alongside state survey data.
The Pennsylvania Health Care Association, which represents for-profit nursing homes in the state, expects to go online in the next few months. It hasn't decided yet whether it will include state survey data.
In Ohio, the association representing for-profit nursing homes is supporting a bill that would require the state to launch an online guide. The guide would include state survey information and consumer satisfaction data.
The Association of Ohio Philanthropic Homes, Housing and Services for the Aging, which represents not-for-profit homes in the state, opposes the bill.
"The consumer is as interested in senior housing, assisted living and community service providers (as in nursing homes), but these (options) are totally absent" from the proposed guide, says Clark Law, president and chief executive officer of the association.
The group's site provides facility-specific data on staffing and expenditures on food for residents, but no state survey data.
Advocates and providers say that making nursing home information so easily accessible may motivate nursing homes to boost quality.