| If you’re looking for a high-quality nursing home, the advice from experts is loud and clear: Do your homework. They advise future residents and their families to dive into government records and conduct their own facility inspections.
They also recommend not rushing to choose a facility. Many people, however, are discharged directly from hospitals to one of the nation’s more than 15,000 nursing homes, leaving little time for research.
There’s no question that nursing homes face serious challenges. Many are short-staffed, a problem that has worsened in the wake of COVID-19. And even before the pandemic, studies found that many facilities were riddled with serious infections.
Those and other issues were underscored in an April 2022 report from the National Academies of Sciences, Engineering and Medicine.
“The way in which the United States finances, delivers and regulates care in nursing home settings is ineffective, inefficient, fragmented and unsustainable,” Betty Ferrell, director of the Division of Nursing Research and Education at City of Hope medical center near Los Angeles and the chair of the committee that compiled the report, said in announcing its release.
That makes it all the more important for older adults and their families to avoid last-minute searches by getting to know facilities in their area in advance, say government agencies, industry groups and advocates for the aging.
Narrow your search
Fortunately, the days are long gone of having to visit state regulatory offices to rifle through paper files. Much of that research can be done online, thanks to digital libraries of ratings and inspection reports.
Some states’ online tools
Check to see if your state offers online tools about facilities. Some that do:
• California provides a handy searchable database.
• Colorado has an easy option for filing complaints.
• Florida allows you to report infections online.
• Illinois gives step-by-step instructions on choosing a home.
• Pennsylvania posts inspection reports on the internet.
• Texas has a user-friendly website to figure out how to pay.
• West Virginia Legal Aid lists ombudsmen statewide.
Note: Check with your state's long-term care ombudsman's office or your state health or aging agencies to find out specifics.
Medicare provides an online tool to help users find and compare nursing homes, hospitals and other care facilities in their area. It uses a five-star rating system and includes information about each ranked nursing home’s staffing quality measures, vaccination rates and inspection reports.
Other useful digital resources include Nursing Home Inspect, a project of the nonprofit investigative news outlet ProPublica that compiles more than 80,000 nursing home inspection reports into a searchable database, and NursingHome411, run by the nonprofit Long Term Care Community Coalition, which offers state-by-state data on facilities’ staffing, citations and ratings.
If a loved one is going straight to a nursing home from the hospital and you don’t have much time to choose, Richard Mollot, the coalition’s executive director, recommends limiting the selection to facilities with four- or five-star Medicare rankings. But he notes that Medicare’s tool has strengths and weaknesses for assessing individual nursing homes.
For example, “the staffing measure is by far the most important and useful indicator of a facility’s quality,” Mollot says. But due to the way Medicare calculates the ratings, a nursing home can rank low for staffing but still get four or five stars overall.
Conversely, “you may have a one-star home, where staffing is five stars,” says Roy Herzbach, regional ombudsman director at Legal Aid of West Virginia. “The numbers can be faulty.”
Studies have shown nursing homes should provide at least 4.1 hours of nursing care per resident per day, including at least 45 minutes of attention from a registered nurse, says Charlene Harrington, a professor emeritus of social behavioral sciences at the School of Nursing at the University of California, San Francisco, who has written extensively on nursing home staffing and finances. But more than a third of five-star nursing homes don’t meet that standard, she says.