Tips for Picking the Right Nursing Home Facility

Do you have a loved one — perhaps an elderly father or mother — who may soon need extended nursing care? Moving a relative into a long-term care facility can be a costly proposition. But there's more to consider than just the price tag.

It's often difficult to determine the quality of care your relative will receive as a resident. Fortunately, amidst public outcry for greater transparency, the Senate recently published a list of roughly 400 facilities with a history of providing poor care. But while this list can help you identify some facilities to avoid, you'll still have to do significant legwork to find a facility that you can trust to provide high quality, compassionate care for your family member.

CMS Search Tool

The importance of nursing home care can't be overstated. According to the latest statistics, about 1.3 million Americans reside in more than 15,700 facilities nationwide. The information released by the Senate shows that approximately 3% of those facilities are plagued by persistent problems.

For years, the names of numerous nursing homes targeted by inspectors as having serious ongoing health, safety or sanitary problems weren't revealed. Although 400 facilities were rated poorly, they weren't included on a shorter list of about 80 so-called "special focus" nursing homes that are subject to increased federal scrutiny.

In June, the Senate released the longer list (compiled in April 2019) provided by the Centers for Medicare and Medicaid Services (CMS). The CMS list includes previously undisclosed homes with documented problems.

To find out which facilities are on the list, visit the CMS's website. A search tool called Nursing Home Compare provides quality of care information for every nursing home that participates in Medicare and Medicaid. You can look up nursing homes by city, country, state or zip code. Or you can search for a specific facility by name. In general, facilities receive ratings ranging from one star for the lowest quality of care to five stars for top-quality caregivers.

In addition to providing an overall rating, the site evaluates facilities on three other criteria:

• Health inspections, based on onsite surveys conducted by state survey agencies,
• Staffing levels, based on the number of nurses available to care for patients at any given time, and
• Quality measures, based on resident assessments and Medicare claims data.

The site doesn't display starred quality ratings for so-called "special focus" nursing homes. Instead, these facilities are designated with a yellow triangle icon resembling a traffic "caution" sign.

CMS has stated that the Nursing Home Compare site ratings are the best gauge for facilities around the country. But consumer groups argue that the ratings are insufficient and more disclosure is long overdue.

4 Steps

The CMS site is a good starting point for finding a high-quality nursing home. But you'll want to do additional research. Here are four steps to help you find a facility that's right for your loved one.

1. Set priorities. What's most important to you? It might be nursing care, meals and housing, physical therapy, hospice care or special needs, such as caring for dementia or Alzheimer's patients. Also, proximity to friends and family can be essential.

2. Obtain referrals. Virtually everyone knows of someone in a long-term care facility. Contact other relatives, friends, and members of your local and religious community for their input. And check with local healthcare providers to see which facilities they recommend.

3. Conduct a preliminary site visit. Interview staff about important details, such as:

• The number of residents,
• The staff-to-resident ratio,
• Levels of care available (for example, assisted living, full nursing care, rehabilitative care and hospice),
• Security measures (for example, surveillance cameras, locks on residents' dressers or apartment doors, and alarms on restricted areas),
• Meals, snacks and beverages,
• Rules regarding distribution of prescription and over-the-counter medications,
• Activities (for example, games, arts and crafts, exercise and educational classes, and holiday events), and
• On-site amenities (for example, religious services, dental care, chiropractors, hair stylists and spa treatments).

Meet with the facility director and head of nursing. Make a list of questions to discuss, such as:

• Is there a waiting list to get in?
• What happens if the resident goes on Medicaid?
• Which specific staff members would care for your relative?
• What's included in the resident's monthly fee — and what will cost extra?
• Is there a formula for price increases in the future, or is the monthly fee fixed?

Also, don't hesitate to ask the "tough questions," such as whether the facility has ever been cited for any actions or acts of omission. High turnover of key administrative positions could raise a red flag.

Even more important, watch the residents and their family members as you tour each facility. Do they seem happy, safe and clean — or agitated and unkempt? Does the food look and smell appetizing? Are there any strange odors or visible trash? Would you want to live at the facility or visit it on a regular basis?

4. Make a follow-up visit. This time, come unannounced. If you previously visited on a weekend, consider showing up on a weekday. A switch usually makes it easy to meet with different staff members because of weekly scheduling. Check out the activities going on at different times. Take a close look at all the meals being served.

Once you've made your final selection, examine the facility's contract carefully. It's likely to be lengthy, so take your time. Ask the director about anything you don't understand. Have someone else — perhaps another family member or close friend — review it with you. Better yet, consult a legal professional if you're unsure about certain items.

New Report on Hospice Care

In another government report, issued in July 2019, the Office of the Inspector General of the U.S. Department of Health and Human Services found that 87% of hospice facilities that provide care to Medicare beneficiaries had been cited for deficiencies from 2012 to 2016. Approximately 20% had lapses serious enough to endanger patients. And 33% of hospices had complaints filed against them.

Hospices are designed to provide end-of-life care for patients who forgo curative care for a terminal illness and instead receive only palliative care. The most common types of deficiencies involve:

• Poor care planning,
• Mismanagement of aide services, and
• Inadequate assessments of beneficiaries.

Unfortunately, it can be difficult for families to assess the quality of hospice care, because the CMS Hospice Compare tool doesn't currently indicate whether a facility has been cited for a deficiency. This information might help caregivers make better informed choices and help hold hospices accountable for the care they provide.

Bottom Line

A facility that appears to meet your standards on the outside may be substandard when you examine the inside. So, it's important to do your homework and avoid taking shortcuts. This is too important a decision to take lightly.