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Indiana Lags the Nation in Nursing Home Quality

Indiana lags the nation in nursing home quality

— Getty Images/Tetra images

The U.S. Government Accountability Office says Indiana has the greatest number of “most poorly performing” nursing homes in the country, at 52. That’s more than California, Florida, New York or Texas.

The Centers for Medicare and Medicaid Services says about half of Indiana’s 500 nursing homes provide a “below average” standard of care, including 102 that rank “much below average” in its Five-Star Quality Rating System.

An independent analysis of state Health Department reports revealed a sharp and sustained rise in Indiana nursing home violations from 2003-2008.

The Indianapolis Star disclosed those troublesome facts and many more in a recent investigative series about nursing home quality. The series revealed chronic understaffing, especially at for-profit facilities; failure to apply $700 million in quality assessment fees to actual quality improvements; and long waiting lists at high-quality facilities.

“Hoosiers deserve better,” says June Lyle, AARP Indiana State Director. “They deserve better care and quality than they’re getting in Indiana nursing homes, they deserve stronger state enforcement of quality standards, and they deserve access to a broad range of home and community based services as alternatives to nursing homes.”

Home and community based services include home or congregate meals, attendant care, homemaker services, transportation, adult day care, respite care, and in-home nursing visits.

Those services are sadly lacking in Indiana, despite people’s overwhelming preference for them and their significant cost advantage (about one-third the cost of nursing homes).

According to the AARP Public Policy Institute, Indiana spent just 5 percent of Medicaid long-term care funds on home and community based services in 2007. That ranked 48th in the nation and well below the national average of 27 percent.

The Indiana Division of Aging reported better performance in fiscal year 2009, when it directed $150 million, or 12.3 percent, of combined state and federal long-term care dollars to home and community based services. But taxpayer-funded nursing home reimbursement rose sharply, too, from $794 million to $1.06 billion.

Conclusion: Too many Indiana nursing homes provide too little quality, yet they remain Indiana’s default option for long-term care.

Like many crises, this one is easier to describe than resolve. But gains are possible through advocacy, legislation, and education to help consumers navigate their long-term care needs and options.

That’s why AARP Indiana conducted seven community forums on long-term care this spring, featuring resource fairs and presentations by Area Agencies on Aging. The “Triple As” offer long-term care resources and care-coordination.

AARP Indiana has also called on lawmakers to cut red tape so people can qualify more quickly for home and community based services.

We’re also promoting two new tools to help people plan and prepare for their long-term care futures, or their loved ones’.

“Planning for Long-Term Care: Your Resource Guide,” is a 52-page booklet that helps you assess and consider your health, finances and wishes. It also includes a long-term care worksheet and resource guide.

“Get the Facts on Long-Term Care” is a two-page fact sheet to jump-start your thinking about long-term care.

Both resources are free and both are available at Or you can order them by calling toll free 1-866-448-3618.

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