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Choosing a Nursing Home Can Be a Daunting Task

Visiting, unannounced at different times of the day, is the best way to make a selection

• Texas ranked 49th in the amount of money its Medicaid program reimbursed nursing homes last year.
• 43 percent of Texas nursing homes rated below average (or worse) by federal inspectors.
• Resources are available to help find a high-quality nursing home.

Alice Bridges and her siblings did their homework before placing their mother, Mildred Earls, in a nursing home. Her advanced Alzheimer’s disease made a full-time placement the family’s only choice.

“We narrowed down our list using ratings from the state and then we’d go to visit,” said Bridges, a retired executive assistant who worked for 42 years at the University of Texas at Austin. “We’d go unannounced in the middle of the day and we let our noses tell us things. At a lot of them we just said, ‘Uh-uh. Not this one.’ ”

They finally settled on a home in Austin, and for nearly two years they were generally pleased with their choice. That changed in December 2008, when Earls fell and it took the home’s medical staff almost two weeks to recognize she had broken her hip. That same month, the U.S. Centers for Medicare & Medicaid Services began posting quality ratings for the nation’s 15,800 nursing homes.

Bridges found the new five-star ratings to be a helpful resource when she looked for a new home for Earls that would be suitable when she was discharged after her hip surgery. But she still took time to visit and interview administrators.

“The one we found did not look the best on paper, but it was an excellent facility,” Bridges said. Earls lived there until she passed away in August at age 89.

Bridges had the luxury of not having a deadline in searching for a place for Earls. Not everyone does.

“In many cases families are trying to find a nursing home for an individual in crisis,” said Amanda Fredriksen, advocacy manager for AARP Texas.

With 43 percent of Texas nursing homes rated below average or lower by federal inspectors, the task of finding a nursing home in the state can be daunting. The federal Centers for Medicare & Medicaid Services five-star system—which measures staffing, health inspection findings and 10 quality measures including the prevalence of bedsores and use of restraints—is a good place to start, Fredriksen said.

“It’s a consumer-friendly way to help figure out what’s out there,” she said. “It works … because even if you can do a lot of research, the average person doesn’t know what questions to ask.”

Texas ranked 49th among the states in the amount of money its Medicaid program reimbursed nursing homes, according to a study last year. Only Illinois spent less per patient. Medicaid is a major payer of long-term care.

Nationally, the average Medicaid reimbursement for nursing homes was $167 per day last year. In Texas it was $120, according to the Texas Health Care Association.

Lower funding can mean lower staff wages, higher turnover and poorer care.

Useful information also can be gained from the Texas Department of Aging and Disability Services’ rating system, which can be accessed online or by phone at 1-800-458-9858. Long-term care ombudsmen, based in the 28 Area Agencies on Aging, can also help. Call 1-800-252-9240., which provides the public with access to government ratings on nursing homes nationwide, is another source of credible information. It also includes a watch list and an honor roll of nursing homes.

Cecilia Fedorov, a spokeswoman for the state aging agency, said ombudsmen can describe facilities and services. “One caveat is they are not a placement service. They can’t help find vacancies.”

As Bridges found, on-site visits are still the best way to assess nursing homes.

“I recommend visiting more than once, and unannounced,” Fredriksen said.

“And you don’t want to assume that a fancy lobby means the quality of care is good. Find relatives of other residents to talk to. You can find them through the home’s family council, if they have one. Just like any other major life decision, it’s important to do your homework. There’s information out there.”

Thomas Korosec has been a journalist in Texas for more than 20 years.

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