Consumers generally do not avail themselves of the multitude of information resources available to them in the process of selecting a nursing facility. Even given the wide variety of information sources available either in print, by phone, or on the Internet, many of the focus group participants perceived that the information they needed or wanted was not available to them when they needed it. Several people mentioned the inability to find a particular type of information that is already available but about which they were not aware, such as facility inspection reports. Denial or lack of understanding about a loved ones condition and the circumstances around hospital discharge often resulted in little time to select a facility, making it difficult to seek out or use what formal information sources are available. In selecting a facility, consumers are most likely to rely on lists of facilities that provide general information such as location, supplemented by word of mouth and more easily observed characteristics of the facility that reflect a sense of quality of life. In contrast, consumers were less concerned with the clinical, more technical factors that influence quality of care.
Consumers based their selection of facility on information often not available on Internet-based resources. Most of the sites we reviewed as part of our content review did not include characteristics that were cited as important selection criteria for many consumers (e.g., information on costs and what activities were available in the facility). Both consumers and information intermediaries found that many of the available Internet resources, including Nursing Home Compare, were not user-friendly, and intermediaries were reluctant to recommend the sites to consumers. Most sites are not available in languages other than English, which some consumers and intermediaries cited as an important barrier to their use.