September 2006
How you can find good nursing home care
The right match Jordan Smith, 23, lives at the Greenhurst Nursing Center in Charleston, Ark. His mom, Connie Smith, says, "There is something
that works here."
Photography by Wesley HittChoosing a humane, well-run nursing home can be one of the most important decisions you’ll make in life. Unfortunately, it
can also be one of the most rushed. Even when good information is available, you may have little time to digest it, especially
if a hospital discharge planner says your relative must be out in 24 hours. He or she will often suggest a particular nursing
home in the area, but you may not know whether the home is your best choice or a very bad one.
If you find yourself in this situation, first know that you can use your appeal rights under Medicare to extend the hospital stay for two days. That will buy you additional time. Then follow these steps:
Get the names of local facilities. The Eldercare Locator (800-677-1116) will refer you to your local agency on aging. It, in turn, can supply you with a list of nursing homes and contact information for the local ombudsman, a government official whose job is to investigate nursing home complaints and advocate for residents and their families.
Consult our Nursing Home Quality Monitor. It will help you cross potentially bad homes off your list. Avoid facilities that have appeared on our list repeatedly and those that performed poorly on two of our three dimensions of quality. If a nursing home near you is on our “good” list, put it on your list of possibilities. Also check state penalty information on our site. If a nursing home has received a state fine, even a small one, consider that a warning.
Check the ownership. A resident’s chances of receiving good care are better at an independent not-for-profit facility than at a for-profit chain. You should ask whether the facility is about to (or has) changed owners. One that’s on the auction block might have problems, just as one with a new owner might be getting better. Be aware that if the facility is part of a large corporation that has split itself into smaller, limited-liability companies, you may have little recourse against the home if things go badly for your family member.
Check with the local ombudsman. He or she should be able to tell you about homes in your area. We say “should” because many ombudsmen have encountered pressure from the industry and are now very careful about what they say. Comments such as “You may want to look further” or an unenthusiastic “They’re OK” could be warning signals.
Don’t depend on the federal Web site. The Centers for Medicare & Medicaid Services maintains a Nursing Home Compare site at www.medicare.gov. But our comparison of the information on that site and the state inspection reports on which it is based show that you’ll probably get an incomplete and possibly misleading picture of any home that you have under consideration.
Visit the homes. Once you’ve narrowed your search, make unannounced visits. Connie Smith of Little Rock, Ark., pictured above, visited five homes, several repeatedly, before selecting the Greenhurst Nursing Center in Charleston, Ark., for her son Jordan, 23, who as a child became a quadriplegic due to a BB gun accident. She’s pleased with the personal attention he has received. When Jordan turned 21, the nursing home administrator put a drop of beer on his lips to mark his coming of age.
Read each home’s Form 2567. That is the facility’s state inspection survey, which should be “readily accessible.” If it’s not and you have difficulty obtaining it, consider that a warning that the facility may be hiding damaging information. A lengthy survey with lots of violations indicates problems. The administrator might tell you they’ve been fixed, which may or may not be true. But even a deficiency-free survey is no guarantee of good care. It may merely mean that the inspectors were not looking very hard.
Visit the homes again. Drop in between 9:30 and 10 a.m., for example, to see how many people are still in bed. Homes with too few staff members don’t get people out of bed until late in the day, if at all. Also visit at dinnertime. If 75 percent of the residents are eating in their rooms, that’s not a good sign. Most people prefer to be out of bed and to eat in the dining room. Ask the nurse aides how many residents they each care for. The smaller the number, the better.
Ask about top-level turnover. If the administrator and the director of nursing have worked at a facility for several years, that’s a positive sign. Frequent changes in those positions indicate instability, which could translate into poor care.
Talk to the administrator. Try to get a sense of his or her philosophy of care and how well it’s communicated to staff members. Good care begins with the facility’s leadership.
If you find yourself in this situation, first know that you can use your appeal rights under Medicare to extend the hospital stay for two days. That will buy you additional time. Then follow these steps:
Get the names of local facilities. The Eldercare Locator (800-677-1116) will refer you to your local agency on aging. It, in turn, can supply you with a list of nursing homes and contact information for the local ombudsman, a government official whose job is to investigate nursing home complaints and advocate for residents and their families.
Consult our Nursing Home Quality Monitor. It will help you cross potentially bad homes off your list. Avoid facilities that have appeared on our list repeatedly and those that performed poorly on two of our three dimensions of quality. If a nursing home near you is on our “good” list, put it on your list of possibilities. Also check state penalty information on our site. If a nursing home has received a state fine, even a small one, consider that a warning.
Check the ownership. A resident’s chances of receiving good care are better at an independent not-for-profit facility than at a for-profit chain. You should ask whether the facility is about to (or has) changed owners. One that’s on the auction block might have problems, just as one with a new owner might be getting better. Be aware that if the facility is part of a large corporation that has split itself into smaller, limited-liability companies, you may have little recourse against the home if things go badly for your family member.
Check with the local ombudsman. He or she should be able to tell you about homes in your area. We say “should” because many ombudsmen have encountered pressure from the industry and are now very careful about what they say. Comments such as “You may want to look further” or an unenthusiastic “They’re OK” could be warning signals.
Don’t depend on the federal Web site. The Centers for Medicare & Medicaid Services maintains a Nursing Home Compare site at www.medicare.gov. But our comparison of the information on that site and the state inspection reports on which it is based show that you’ll probably get an incomplete and possibly misleading picture of any home that you have under consideration.
Visit the homes. Once you’ve narrowed your search, make unannounced visits. Connie Smith of Little Rock, Ark., pictured above, visited five homes, several repeatedly, before selecting the Greenhurst Nursing Center in Charleston, Ark., for her son Jordan, 23, who as a child became a quadriplegic due to a BB gun accident. She’s pleased with the personal attention he has received. When Jordan turned 21, the nursing home administrator put a drop of beer on his lips to mark his coming of age.
Read each home’s Form 2567. That is the facility’s state inspection survey, which should be “readily accessible.” If it’s not and you have difficulty obtaining it, consider that a warning that the facility may be hiding damaging information. A lengthy survey with lots of violations indicates problems. The administrator might tell you they’ve been fixed, which may or may not be true. But even a deficiency-free survey is no guarantee of good care. It may merely mean that the inspectors were not looking very hard.
Visit the homes again. Drop in between 9:30 and 10 a.m., for example, to see how many people are still in bed. Homes with too few staff members don’t get people out of bed until late in the day, if at all. Also visit at dinnertime. If 75 percent of the residents are eating in their rooms, that’s not a good sign. Most people prefer to be out of bed and to eat in the dining room. Ask the nurse aides how many residents they each care for. The smaller the number, the better.
Ask about top-level turnover. If the administrator and the director of nursing have worked at a facility for several years, that’s a positive sign. Frequent changes in those positions indicate instability, which could translate into poor care.
Talk to the administrator. Try to get a sense of his or her philosophy of care and how well it’s communicated to staff members. Good care begins with the facility’s leadership.
