Grading the quality of care

When the family of a prospective resident begins the search for an assisted living or nursing community, the quality of care they will receive is naturally a key factor in their decision. Demonstrating how a retirement home performs in this regard has long been a challenge for administrators. Touring a facility and interviewing staff members can provide valuable insight into how a facility is run, but for some families, a more tangible measure of results is better yet.

My organization, CRL Senior Living Communities, recently took on a new initiative that has the potential to help residents seeking objective information about care at our 16 locations. Earlier this month, we published our first “Clinical Outcomes Report Card,” which measures facility performance in several key areas against our peers.

Using data collected by the Centers for Medicare & Medicaid Services and reported on its Web site,, the report card tallies the prevalence of weight loss, dehydration, pressure ulcers, incontinence, and other conditions to which the elderly are particularly susceptible. While anyone can view this information on the Medicare site, few seniors know it’s available and go about trying to find it. By compiling these facts into a biannual report card for them, prospective residents have a convenient tool for comparing our facilities to others in Illinois and Wisconsin, the two states in which we operate.

When members of our admissions team meet with prospective residents, they can now point to clear evidence that, for example, our incidence of weight loss is roughly one-third that of competing communities. Other criteria in the document, from the number of falls to the utilization of anti-anxiety medications, likewise show residents a commitment to quality rather than just telling them it exists.

Our management team has already identified a number of vehicles through which we can disseminate the results more broadly—we’ve issued a press release and included results in our monthly e-newsletter, the news section of our Web site, and the organization’s blog. The possibilities certainly don’t end there.

Staff members can also share the report card with physicians and social workers, where it can help reaffirm their confidence in a facility’s performance. These professionals are an important source of referrals, so any tangible measure of a community’s quality can go a long way.

While wellness activities such as Wii bowling tournaments don’t appear on the report card, they are still vital to your facility’s quality initiatives.

Of course, the effectiveness of the report card as a marketing tool is only as good as the results within it. The document can help the staff identify areas where they can be even stronger. For organizations that pride themselves on delivering exceptional care, it represents an important change management tool.

Even if your organization only releases a formal report card twice a year, you can compare your outcomes to the Medicare database on a monthly or quarterly basis for internal purposes. For areas that need improvement, consider having your nursing staff make “plans of correction” in which they lay out concrete steps to address the issues at hand. For organizations that have multiple locations, this process can become a way of developing best practices across your enterprise.

In the future, it is possible that criteria will be standardized and clinical report card data could be used to rank communities. We are already working with the Wisconsin Assisted Living Association to establish such a system in that state.

While we’re already seeing numerous benefits from the report card, it certainly doesn’t tell the whole story of a long-term care community. For instance, many of the programs we run to enhance the social and mental wellbeing of our residents—from yoga classes to live entertainment—don’t show up on the scorecard. However, great providers will instantly recognize that these types of activities are connected—and work in concert with—clinical care in a holistic way.

Implementation of a new reporting tool can be challenging. Compiling data and analyzing the results is a fairly time-consuming endeavor. Nurses may be reluctant to buy into a report card at first, but when you present it to your organization as an opportunity to improve and attract more residents, transparency soon becomes something everyone can embrace.

Michael Munter is chief operating officer of CRL Senior Living Communities (, an organization with 16 facilities in Illinois and Wisconsin, serving seniors with needs in independent and assisted living, along with Alzheimer’s and memory care.

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