How to Compare Nursing Homes

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With lengthening life expectancies and an aging population, many families in the United States are in a position where they have to determine which long-term care options they’ll utilize for their loved ones. 

For many families, nursing homes are the best option. They provide constant supervision and medical care, and that’s something that you might not be able to provide for your loved one otherwise. 

It’s scary, however, to choose a nursing home. You are quite literally putting your loved one’s life in the hands of the facility and its staff, so you want to make the right choice. 

You might also have heard horror stories about some of these facilities. 

Most nursing homes do offer quality care, but there are some factors you should rely on as you make a decision. For example, one tool you can use to compare facilities is Medicare’s Nursing Home Compare, which allows you to see ratings of nursing homes and what they offer compared to other local facilities. 

While that’s one option, it shouldn’t be the only one. 

The following are some things to know as you begin the process to compare nursing homes. 

Medicare Nursing Home Ratings

The Medicare nursing home rating system was first introduced in 2008, and it recently underwent a revamp in 2019. The Centers for Medicare & Medicaid Services uses a five-star scale in three categories. 

One-star indicates a facility is very below average in the category, while five stars represent being above average in a category. 

The categories used in these ratings include:

  • Health inspections: One thing Medicare bases its star ratings on is health inspections. Specifically, ratings are based on the three most recent yearly health inspections. These ratings are also based on investigations of complaints made against the facility at that time. 
  • Staffing: This rating category assesses the number of hours specific staff members provide care to residents. This includes nurses, physical therapists, and certified nursing assistants. 
  • Quality measures: This third category used by Medicare for star ratings looks at several sub-categories, including the  number of residents who require hospitalizations, the number of residents with new or worsening bedsores, physical restraints, and how many received certain vaccinations. 

While the Medicare rating system is one way to assess a facility, it’s not the only one and there are issues with this system. 

For example, the New York Times found that the federal government provides monetary incentives to facilities based on their ratings. A five-star rating means that a facility receives $2,000 in profit per bed, and those facilities that have three or four stars have a profit of $1,000 per bed. 

Another issue is that a lot of the information is self-reported from the facilities themselves. 

There are also some indications that nursing homes have advance notifications of what are supposed to be surprise inspections. 

Joint Commission Accreditation

The big takeaway as far as Medicare ratings is that yes, you can use these to guide your search somewhat, but they shouldn’t be the only factors you look at. 

The Joint Commission is an accrediting body that you might look to in your search for a facility. 

The Joint Commission on Accreditation of Healthcare Organizations has a well-respected reputation in health care for their grading of long-term care facilities. The program was launched in 1966, and currently, there are around 1,000 organizations that are accredited and offer long-term care

Organizations eligible for accreditation include beds licensed by the state as nursing home beds, beds designed for long-term care under a hospital license, beds or facilities certified by Medicare or Medicaid as being skilled nursing beds, and beds or facilities that are part of a governmental entity like a VA facility. 

To earn accreditation from the Joint Commission, facilities have to go through an on-site survey every three years. This survey looks at care provided, and it also provides continuing guidance and education to staff so that performance is continually improved. 

The survey process looks at actual care being provided and treatment and services. It also looks at operational systems that affect the quality of patient or resident care. 

There are two types of accreditation. 

There’s the traditional long-term care accreditation, which requires that the facility is compliant with Joint Commission long-term accreditation requirements. There’s also the Medicare/Medicaid certification-based accreditation. This requires a facility or organization to comply with any Joint Commission standards not addressed by the conditions of participation from Medicare/Medicaid. 

Other Accreditation Programs

Aside from the Joint Commission’s accreditation, which is often considered the gold standard, there are some others too. 

For example, there’s the Accreditation Commission for Home Care, Inc. This is a little different because it’s for home health care companies and providers specifically. This accreditation works to ensure that agencies follow best business practices, and staff has to receive continuing education and health screenings to be eligible. This accreditation organization doesn’t conduct home visits, however. 

The Continuing Care Accreditation Commission is associated with the Commission on Accreditation of Rehabilitation Facilities (CARF). This is a senior care accreditation body, and a facility does have several months to prepare for a visit from a surveyor. 

The Community Health Accreditation Program or CHAP conducts home and site visits for businesses that provide home care. 

Even beyond the things above, there are other organizations that provide independent ratings and reviews of care facilities. 

For example, U.S. News & World Report has nursing home ratings. 

The U.S. News Best Nursing Home Ratings were started in 2009, and they use data from Nursing Home Compare, but this is from Centers for Medicare & Medicaid Services. 

In 2019, U.S. News & World Report added a long-term care rating evaluation for residents that can’t live independently and need help with daily tasks. 

Overall, the big takeaway is that you shouldn’t rely on one rating system, including Medicare ratings. Instead, you should look at a broad set of data when you’re choosing a nursing facility, and you should also visit yourself and get to know it before you make a choice.