There's an old saying that goes, "If you want to know how good it is, ask someone who owns one." Translated into the health care industry, that means that if regulators, policy-makers, health care providers and payers want to know how well health care services are being provided, they should ask consumers who have used the services.

Increasingly, that approach is being taken in the area of consumer perceptions about health care. Satisfaction surveys are being conducted by the federal government, HMOs, public health agencies and private foundations. One of the newest and most significant of such surveys, the "National Survey on Nursing Homes," probes the perceptions of consumers about the nation's nursing homes.

This survey, conducted from April 23 to June 3, was sponsored jointly by "The NewsHour with Jim Lehrer," the Kaiser Family Foundation and the Harvard School of Public Health. More than 1,300 randomly selected adults participated in the telephone survey, including 323 with substantial nursing home experience. This group was defined as those who, in the past three years, have been residents in nursing homes or have known someone in a nursing home and visited them at least once a month during that time.

The survey found that people with substantial experience with nursing homes generally had positive views about the staff. Seven out of 10 respondents (71 percent) felt that staff are interested in and responsive to family members' concerns, and 69 percent felt that staff handle their jobs with skill and care. Six out of 10 respondents (62 percent) felt that nurses handle procedures with skill and care.

While nursing home staff generally enjoyed positive perceptions about their work among consumers, facility administrators had some problems.

For example, of those consumers with substantial experience with nursing homes, more than half (56 percent) said that when they filed a complaint with an administrator, the administrator failed to resolve the complaint satisfactorily. Administrators fared poorly on the question of sufficient staffing, too, with nearly six out of 10 (58 percent) respondents saying there is not enough staff.

Administratiors also missed the mark on providing a "homelike environment" in the eyes of those surveyed. Seventy percent said the nursing home feels more like an institution than a home.

Some findings should be troubling to both staff and administration. One in four respondents with substantial nursing home experience said they knew a resident who had been treated badly or abused by staff. Nearly as many (23 percent) said they knew a resident who suffered the development of bedsores, and just as many said they knew a resident who had been overmedicated.

Overall perceptions of nursing homes were mixed. About one-third of respondents (34 percent) said nursing homes do a good job meeting residents' needs, about one-third (35 percent) said they do a bad job and the remaining third was split between having mixed feelings or saying they did not know. However, among those with substantial nursing home experience, the numbers were markedly worse: 47 percent of those respondents said nursing homes do a bad job.

A popular misperception about nursing homes was confirmed by the survey-the notion that once patients enter a nursing home they will never come out. Eighty-six percent of respondents said they believed that once a person enters a nursing home, he or she never goes home. However, the survey reported that 29 percent of nursing home residents admitted in 1997 did go home after their stay; only 27 percent died in the facility.

The government shares the blame for the quality problems in nursing homes, according to the survey. Thirty-nine percent of respondents strongly agreed that the government does not enforce quality standards in nursing homes and another 26 percent somewhat agreed. Forty-two percent felt that there was not enough government regulation of nursing homes.

Even more people felt that the government should do more to help pay for nursing home care. Seventy percent of respondents favored the federal government doing more to pay for nursing home care, even if it meant a substantial increase in taxes. Forty-six percent favored doing this by expanding Medicare and Medicaid, while 21 percent favored tax credits.