When it comes to placing a parent or grandparent in a nursing home, how much do you actually know or want to know about the facility?

It turns out some local establishments are doing a great job while others are not, according to available records. So Patch decided to conduct a special investigation to take a close look at the facilities in Deerfield and Highland Park.

The two neighboring villages have a total of three nursing homes, which get rated on a five-star scale by a federal agency. The rating system, enacted in 2008, is designed to help would-be residents and their families make the right long-term care choice.

"It can help you frame questions but it can’t give you an absolute answer of whether or not it’s a good facility for you or not,” Janet Wells, spokeswoman for the National Consumer Voice for Quality Long-Term Care, said of the government evaluation.

Don't get them confused

First, the difference between a nursing home and an assisted living facility needs to be clarified.

    * Nursing homes offer 24-hour care and supervision, with alternative names being skilled nursing, long-term care or sub-acute facilities. Residents are provided rooms, meals and recreational activities. They also may receive assistance for such daily activities as eating, bathing, dressing, going to the bathroom and walking.

    * Assisted living facilities focus on enabling people to live independently. They are not an alternative to a nursing home because only intermediate long-term care is available. The facilities do help residents with eating, bathing, dressing, laundry, housekeeping and medications.

In Illinois, there are 1,200 nursing homes serving 100,000 people in more than 350 municipalities. The three facilities in the area--Whitehall North in Deerfield as well as Abbott House and ManorCare in Highland Park--are for-profit entities with the number of beds ranging from 106 to 208.

Accreditation, licensing, inspections and regulations fall to public and private agencies, including the Illinois Department of Public Health (IDPH), the U.S. Department of Health and Human Services (HHS) and The Joint Commission.

'A starting point'

Jonathan Rosenfeld, a Chicago lawyer who represents individuals abused at long-term care facilities, says the star-rating system is a helpful guide.

“It is a starting point," he said. "There’s so much information out there that it can be overwhelming. I think when you use the star-rating system in conjunction with some other resources and then go out and do visits on your own, it does help."

HHS has its Centers for Medicare & Medicaid Services (CMS) supervise the tiered program, which receives rating information from the states. When the evaluations started in 2008, five stars meant "much above average;" four, "above average;" three, "about average;" two, "below average;" and one, "much below average."

Because Abbot House, ManorCare and Whitehall North receive Medicaid and Medicare subsidies, they are subjected to the federal appraisal. The rating system uses health inspections, staffing levels and self-reported quality measures in its checklist. Additional information about the program is available by clicking here.

How they stack up

The three local facilities run from the high to the low on the scale. Abbott House is at the head of the class with five stars, ManorCare filled the middle with three stars and Whitehall North landed near the bottom with two stars.

Some critics contend the rating system is unfair because inspections and licensing laws vary from state to state. However, Wells is among those who say most people compare nursing homes within their state or local area.

“I think CMS did the best it could," she said.

After obtaining state health inspections of nursing homes in the area, Patch researched incidents that could have contributed to the low scores.

One of those dealt with a patient who checked into Whitehall North in September 2009 and was documented as prone to falling. According to a state inspection, staff members were notified about her 19 falls at a previous facility.

They were also instructed to use a lap tray to secure the woman in her wheelchair. The tray was to be removed for meals and activities only, so long as the resident had one-on-one supervision.

The inspection noted on Sept. 2, 2009, the 90-year-old had her lap tray removed when she fell. Apparently, the staff attendant was assisting another resident when the incident occurred. He told the state agent while his back was turned, he heard a “thump” and turned around to see the woman on the floor.

Records indicate she complained of pain to her right knee and a large bruise was visible on the right side of her head. After seeing a physician, an X-ray showed her right leg's distal femur was fractured.

Knocking down the score

That September incident was the only fall on record during the past year at the Deerfield nursing home. But falls seemed to be a more common occurrence at ManorCare.

Within a month’s time in 2009, three residents fell, bringing the tally to 23 falls at ManorCare. These chronic episodes were signs of a bigger problem, according to Rosenfeld, who said they should have raised a red flag for the facility operators and patients' families.

“Situations where someone is falling on a regular basis, that’s pretty much indicative of not just a problem with one or two staff members," the lawyer said. "It’s indicative of a problem throughout the whole facility. It’s a facility that’s just generally poorly run.”

One resident was found to have fallen eight times during a four-week period at ManorCare. A physician’s assessment was made Oct. 1, 2009, in which the doctor recommended in the report “to improve risk for safety and decrease injury from falls restraint was deemed to be necessary.”

According to state records, staff tried to remedy the situation with wheelchair restraints. However, the patient fell four more times that month after the doctor's assessment. Two of those falls required X-rays.

In late October a state inspection team found the restraints were absent from the patient’s wheelchair.

Records showed a second patient fell 11 times in about a month’s time in 2009. A third fell four times in a little under three weeks.

The three patients sustained bumps, bruises and rug burns from the falls and, in some instances, the state inspectors noted staff failed to update the care plan to address prevention and remedies.

“We feel our centers provide quality care to the patients we serve and we strongly urge all patients and families to use this rating system as only one tool when considering a skilled nursing center,” said Julie Beckert, spokeswoman for ManorCare.

ManorCare was the only local nursing home that returned Patch’s calls for comment.

Inadequate remedies

Lap trays are a common form of wheelchair restraint and can be necessary to prevent these types of situations, said Melaney Arnold, a spokeswoman for IDPH. In some instances, however, restraints can be used excessively and in the form of medication.

“Sometimes the line is blurred,” Arnold said. “Rather than redirecting them to a different room or activity, sometimes it’s easier to use medicine to sedate a resident and sometimes it is necessary. But sometimes there are facilities that overuse medications to do that.”

The state found that after the falling episodes at ManorCare, prescription drugs were used to sedate the patients. Lorazepam and Ambien were given to one patient in the dementia ward on a regular basis. But in his care plan, the drugs were used without explanation.

Ativan and Risperdal were prescribed to deter another constant faller. Even though the patient continued to fall, the dosages were upped without explanation in the person’s care plan.

Not the whole picture

Rosenfeld notes, unfortunately, mistakes do happen. He says facilities and family members need to be aware of chronic mistakes and forms of neglect, such as bedsores.

However, Beckert contends the reports don’t always give the whole picture.

“Centers fluctuate between scores every year depending on the date submitted," said the ManorCare spokeswoman. "The five-star postings are often out of date by the time they are posted. The five-star rating does not measure the programs and services that go above and beyond the basic care.”

Editor's Note: On Tuesday, Patch will continue its special nursing home report and explain why mistakes don’t always mean patient neglect.