Ratings, rankings, inspections, reviews, lawsuits: There is a mammoth amount of information available on the internet for any single nursing home.
But some resources might be more trustworthy than others, and a recent study by the University of Southern California casts doubt upon what is widely considered the most trusted one — Nursing Home Compare, run by the federal government — as a sole resource.
The study compared consumers' Yelp scores to scores reported by Nursing Home Compare. Scores from Yelp users were lower, the study found.
Consumers are left to wonder what tools they should trust. Experts say the answer lies in searches, both online and in person, and gut instinct.
Many complain the Nursing Home Compare website, run by the federal Centers for Medicare & Medicaid Services, is difficult to use. Dr. Anna Rahman, one of the USC study's authors, said consumers have increasingly turned to user-friendly review websites like Yelp and Google to leave their impressions of a health care facility.
Rahman said consumers shouldn't rely on just one rating, not even the government's. No single metric will be totally reliable.
"I’m not saying they’re completely useless," she said. "They’re just not completely trustworthy."
Teresa Arnold, the state's Columbia-based AARP director, said she uses the Nursing Home Compare tool and would eliminate a home from the pool if it had a 1- or 2-star rating. She cautioned against relying upon the system's score alone, though.
"Don’t just go by the stars," Arnold said. "You need to go and check these places out."
Rahman had a few tips: Visit the home when staff are serving a meal, compare ratings from as many sources as possible and ask administrators about staff turnover rates. She said people should not trust Nursing Home Compare's ratings just because they come from the government.
Nursing Home Compare's ratings are often manipulated, the study reported, because companies systematically game the government's tool. It is in a nursing home's financial interest to have a better rating, Rahman said.
Nursing Home Compare combines a range of variables that contribute to a star rating. Consumers often fail to look past the star rating, however, to see what makes up the score.
Eric Hadley, who worked in nursing homes for 23 years before turning to management of assisted living facilities, said families should have a few homes researched before the choice becomes imminent. He encouraged consumers to take a closer look at some of the key areas the government tracks.
"It’s a maze, and it’s very, very confusing," Hadley said. "A lot of people just put trust in the system."
The prevalence of pressure ulcers, commonly known as bed sores, is one measure the government reports. If too many residents in a home have the sores, it may be a sign there is poor staffing and management of care.
But it's not easy to find information about pressure ulcers for any specific facility. The data is included on Nursing Home Compare's website, but users must search for it.
Take, for example, Riverside Health and Rehab, a nursing home in North Charleston.
According to the federal government, 12 percent of long-term residents at the facility developed pressure ulcers. The state average is 6.7 percent.
Inspectors found at least three residents in early 2015 with serious sores. Residents often enter nursing homes with the sores already. But under Riverside's care, the ulcers reportedly worsened.
Deep in the facility's inspection reports, available on the Nursing Home Compare website, the facility's director of nursing is quoted: "We do have a problem with our pressure sores. I saw that when I first came to work here. We are working on it. Our system is broken."
Brigitte Miller, a spokeswoman for Riverside, declined to coordinate an interview. She said in a statement Riverside is "committed to continuous improvement and quality care."
But that information isn't immediately apparent during a quick look at the facility's Nursing Home Compare profile. Its 1-star rating is cause for concern but it doesn't paint the full picture, as two 5-star reviews on Google indicate. Nursing Home Compare's profile names a few areas it does well in.
Meanwhile, at least six civil lawsuits have also been filed against Riverside Health and Rehab in Charleston County court for its handling of pressure ulcers. Families contend that Riverside allowed their relative's pressure ulcers to become exacerbated to the point that they had to be sent to the hospital.
Civil lawsuits against nursing homes are common. They are one insight into a facility's level of care, which must be weighed against the plethora of other sources of information, and they aren't always easy to find. Some county courts don't make documents available online.
Consumers may also access nursing home inspection reports through the S.C. Department of Health and Environmental Control. But they, too, can be dense and shrouded in bureaucratic language.
DHEC inspection reports for Riverside Health and Rehab show the facility has been repeatedly accused of short staffing, poor record-keeping and poor care. DHEC inspectors will visit a facility to follow up with complaints. If an inspector finds the complaint to be valid, it will cite the facility and usually require it to issue a plan of correction.
DHEC visited the North Charleston facility on at least 18 occasions to investigate complaints since the beginning of 2015. They were cited only a handful of times, however. And there is no mention of pressure ulcers.
In contrast to Riverside's 12 percent, about 2 percent of Franke Seaside's residents had a pressure ulcer, according to the government's calculation. The 44-bed facility in Mount Pleasant has a five-star rating from CMS.
"It’s very personal what we do here," Scurry said. "We’re able to eyeball every resident every day."
Hadley said while the Nursing Home Compare tool is useful, it can also be misleading. A high percentage of residents with pressure ulcers may mean the facility actually handles them well, and people with the sores are being recommended to that facility.
Riverside Health and Rehab also has nearly four times the capacity as Franke Seaside. A greater number of patients is naturally more challenging to care for, said Sheena Janse, president of Care for Life Charleston, a company that advises on long-term care.
Janse said to keep in mind every facility will have its low points. Those low points can be learned and weighed with a facility's highlights, she said. She said she thinks consumers are more informed today than in the past. Nothing can replace an in-person visit, she said.
"I would encourage any person who’s looking at placement to go to the facility," Janse said.