Sizing Up Nursing Homes Via Technology

Happy birthday to the 10,000 baby boomers who turn 65 today—and every single day! According to the U.S. Census Bureau, by 2029 when all of the boomers will be 65 and over, more than 20 percent of the total U.S. population will be above normal retirement age. As this demographic ages, there will be many, many nursing home beds to fill: the current number of 1.7 million will no doubt increase. And never before in the history of healthcare have consumers had so many choices about the care they receive and where they receive it. Residents, who are well educated about their conditions, treatments and care environments, expect their wants and needs to be fulfilled as they make the transition from traditional home to facility-based care.

To meet resident demands successfully, nursing home administrators need to proactively assess various performance categories. Conveniently, the U.S. federal government collects and publishes rich data sets on healthcare provider performance as it relates to quality, staffing, outcomes, penalties, patient satisfaction, ownership, and other nursing home attributes. But rather inconveniently, when administrators seek to compare quantitative and qualitative provider’s statistics against national or state averages—or against other nursing homes—the resultant output is in typically hard-to-read data tables, dotted diagrams or other abstract formats. Numeric facts, baffling figures and confusing graphs hinder decision-makers from achieving transparency and taking action on improvements.

Automated benchmarking: a standard method improved by new technology

Benchmarking is a widely used method to compare how a facility is doing compared to others. Many nursing home administrators make good use of benchmarking to inform their business and marketing strategies. At the same time, traditional benchmarking has severe limitations that often prevent the administrator from getting meaningful and actionable insights. For example, the administrator, or a professional he or she partners with, typically formulates a peer group for a facility and then specifies metrics that are of interest. More metrics and more peer groups mean more expense because the work is very manual (vs. automated) and highly involved. Selection of one or a few peer groups and metrics by individuals also means there is a certain bias to the results due to the limited and selective nature of benchmarking attributes.

Moreover, benchmarking usually relies on quantitative metrics, because they lend themselves to simple comparisons that can be easily conveyed in a diagram. With qualitative or yes/no questions, the answers also narrow the field of resulting insights.

With numbers and yes/no answers to work with, it is impossible to produce insights that are fully comprehensive and motivate and direct action: Does this result matter? Does it deserve attention now?  What could be done? Which action is most appropriate? How to best carry out this action?

Thankfully, technology is reshaping the way benchmarking is done, along with other areas of work and life. Software automation can search for solutions within a larger space of possibilities – peer groups and metrics – than people can, thus uncovering and expressing comparative performance insights in a way that humans have not and would have great trouble doing. Automation also enables cost reduction, reliability, and handling ever-larger and regularly-updated data sets, which should also include changes over time, not just the last period’s measurements. These benefits matter especially if benchmarking is to be repeated regularly.

Technology is also capable of delivering these comprehensive, objective insights in the English language – this is, after all, how we people communicate! For example:

In Connecticut, only Nursing Home A has both as many short-stay residents who were rehospitalized and as many short-stay residents who had an outpatient emergency department (ED) visit.

An administrator of this nursing home will do well to look into why so many residents in the facility end up back in a hospital or ED, especially if this is the highest incidence compared to all other independently owned nursing homes with under 100 beds in the county.

Articulating excellence in marketing materials

The ability of automated benchmarking to deliver a new level of transparency and market understanding is extremely valuable for nursing home professionals, prospective patients and their families as well as other decision-makers. Searching facilities and comparing them to others like them or in proximity to them generates comparative statements about how the facilities measure up. People are drawn to this “apples to apples” type of outlook as opposed to a dry reporting of straight-up facts and figures.

If patients are comparison shopping, they want to know what makes a nursing home better than the one down the block. Effective marketing materials based on such factual, objective comparisons will help a nursing home to communicate exactly how and where it is excelling.

When evaluating numerous available facilities, potential residents and their families want to know which nursing home can adequately meet their desires for care. For some prospective residents, finances, geography or religious affiliation narrow the options. But for many aging adults, performance measures accurately demonstrate a nursing home’s ability to meet their needs. Nursing home administration can connect with potential residents by highlighting these measures in a clear and appealing way with an impactful frame of reference. Automated benchmarking allows the administrator to do just that with language-based, context-rich insights that will help a prospective resident decide—based on the current health status and future needs—if a facility is the right fit. The information can also prompt a dialogue between the administration and prospective residents where they can discuss strengths and weaknesses as compared to other facilities.

Administrators can communicate favorable insights delivered by automated benchmarking through a variety of marketing avenues—online, through social media, in pamphlets or other print advertising materials. The materials deliver the biggest punch when they can say:

Nursing Home A in CA is the only one of 36 nursing homes in Sacramento County, CA which has a 5-star rating in each of overall, health inspection, quality measures, and registered-nurse staffing (4 total).

Furthermore, stakeholders can consider how combinations of attributes work together to impact quality of care. Automation uncovers and expresses comparative performance insights that provide the “I matter because….” context for data in a way that humans generally don’t.

Performance Improvement through automated benchmarking

Securing residents under nursing home care is only one piece of the puzzle. Once a facility has filled beds, safety of care provision and performance are paramount. Administration needs to understand how it’s doing, where it could improve, what has changed over time, and what’s best in class. Facilities seek top scores for safety, nutrition, health outcomes, cleanliness, readmission, bed occupancy, and staffing hours per resident, to name a few. But to figure out what performance targets are achievable in practice, administrators need to examine what similar entities have done and are doing on an ongoing basis. This can be easily accomplished with automated benchmarking incorporated into business and operational planning activities.

Next steps

If the best data practices can be paired with a complete rethinking of benchmarking methodology, then it’s possible to achieve unprecedented performance transparency in nursing homes where rich government data are published. Automated benchmarking generates language-based factual insights that objectively compare a facility to others in multiple peer groups, enabling and motivating thoughtful consideration of what actions to take and how quickly. Nursing home administrators can take advantage of these insights to achieve their goals and meet the heavy demands of top-notch care provision.

Raul Valdes-Perez, PhD, is CEO and Andre Lessa, PhD, is CTO, and both are co-Founders of, OnlyBoth Inc., based in Pittsburgh, Pa.

I Advance Senior Care

I Advance Senior Care is the industry-leading source for practical, in-depth, business-building, and resident care information for owners, executives, administrators, and directors of nursing at assisted living communities, skilled nursing facilities, post-acute facilities, and continuing care retirement communities. The I Advance Senior Care editorial team and industry experts provide market analysis, strategic direction, policy commentary, clinical best-practices, business management, and technology breakthroughs.

I Advance Senior Care is part of the Institute for the Advancement of Senior Care and published by Plain-English Health Care.