Don’t Fall For the Chandelier Effect

April 28, 2015
Virgil Thomas,


Perhaps you saw the New York Times article this month In Race for Medicare Dollars, Nursing Homes May Lag. If you haven’t I would recommend taking the time to read it. The article touches on many distinct issues including how the race to capture high levels of Medicare patients is leading to fancier and fancier facilities but their actual capabilities are creating health risks. “Decadent hot baths,” pristine grounds, and beautiful 5-star-esque lobbies have become the main focuses of institutions trying to turn a profit in an ever changing world of reimbursements.


The care offered by these institutions often lags far behind what you would expect of a building with a giant Chandelier in the front hall

But in a cutthroat race for Medicare dollars,nursing homes are turning to amenities like those to lure patients who are leaving a hospital and need short-term rehabilitation after an injury or illness, rather than long-term care at the end of life.

Even as nursing homes are busily investing in luxury living quarters, however, the quality of care is strikingly uneven. And it is clear that many of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.

The consequences can be dire and it can end up costing the system even more money through rehospitalization.

The home had a reputation for quality and got high marks from the federal government. Until a recent revision, its website promised “top-notch health care” with amenities including a staff willing to administer a “decadent hot bath” at any hour of the day.

But just one month after arriving at Watermark for short-term rehabilitation of an injured foot in 2012, Dr. Johnson-Hamerman ended up in the emergency room with a severe bedsore that had become dangerously infected. Far from the service she said she had been promised, she said the workers never gave her a full bath or shower, were slow to respond to her requests to have her diaper changed and did not turn her every few hours, a crucial step in preventing bedsores.

She said she left the facility only after friends, including doctors and nurses, insisted that she be taken to a hospital.

Geriatric researchers call this disconnect the “chandelier effect.” Attractive lobbies and enticing amenities do not always mean that a home provides good medical care.

The point of all this, from my perspective, is that good care does not come from the luxuries you see in the marketing brochure. It comes from the people and the culture of care that a home creates. The disturbing part is that those intangibles are often overlooked in a system that is so driven by reimbursement and payor make up.

2 Comments. Leave new

This sounds a lot like the “polishing a roof tile” analogy that Dr. Thomas used to refer to. If you do not genuinely care for the people who come for services and support, whether they stay for a short time or a long time, it won’t matter how pretty the lobby is. How do we convince the families that they should not just look at the interior decorating skills of the organization, but rather ask questions about how they empower and get to know the people that come to live there?

Jennifer Berg
May 14, 2015 10:30 am

How about both! Provide an amazing atmosphere, that happens to be beautiful, AND provide amazing skills of honoring the Elders that come through the doors. Was just yesterday visiting a home for Elders – All was well until I went into a bathroom of a resident…it was clearly neglected – old fixtures, the toilet needed repair and so on…I believe the neglect of a facility can certainly mean neglect of it’s residents…


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