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With the rise of the older adult population, has come a sharp decline in the quality of care provided at nursing homes and other long-term care facilities. For decades, serious concerns have been raised about the quality of care in nursing homes. As our older adult population grows, so too does our responsibility to ensure their safety and well-being in nursing homes and other settings where long-term care is provided.

How to choose the right nursing home for your family member

The federal government’s Nursing Home Compare website is one resource for evaluating U.S. nursing homes certified by Medicare or Medicaid. The Center for Medicaid and Medicare Services launched the Nursing Home Compare website in 1998 to help consumers and their families find a nursing home and to encourage the facilities to achieve higher quality through public reporting of nursing home performance.

Nursing Home Compare provides star ratings based on quality measures for all Medicare- and Medicaid-certified nursing homes. While the star ratings provide information about the quality of care provided at nursing homes, the ratings have been criticized because of heavy reliance on self-reported data.

A study by the Center for Public Integrity found that more than 80 percent of facilities reported higher registered staffing levels on the public Compare website than those the Center calculated through cost reports made annually to the state-federal Medicaid program.  In addition, daily staffing levels were lower in thousands of cases.

In February 2015, the government modified its star rating system to address some of these concerns. The changes didn’t bode well for a large number of U.S. nursing homes, whose quality scores dropped under the revamped system. More than one-third of the nation’s nursing homes, which account for 39 percent of all nursing home residents, received low ratings of 1 or 2 stars under the new system, according to a recent analysis by the Kaiser Family Foundation.

Explaining the current five-star rating system

The current five-star rating system calculates an overall star rating – with one star being the lowest possible score and five being the highest – based on performance in three types of measures:

  1. State health inspections, which provide several types of information on nursing home deficiencies identified during annual inspections, including the number and severity of the problems, such as failure to prevent or treat pressure ulcers or environmental hazards like electrical fires.
  2. Staffing measures, including information reported by nursing homes on the ratio of nurses to residents and measured by nurse hours per resident days and calculations of both RN hours per resident days and total nurse hours per resident days.
  3. Quality measures, which are calculated using an assessment tool that nursing homes use to document the function and health status of their patients.

If conducting research on Nursing Home Compare, follow these simple steps:

  • When evaluating the Quality Measures rating, compare a facility’s score with other facilities in the area and look for facilities that score below the state average – the lower the better.
  • Review the star rating summary for each quality measure.
  • Look for how many and what type of health deficiencies were found as compared to the national average and view the full report for more detailed information. If you visit the facility, ask about specific deficiency citations and how and when they were addressed.
  • Evaluate the staffing levels to see which facilities have high levels of RN staffing compared to the national average as well as the number of Certified Nursing Assistant hours.
  • Find the total number of licensed nurse staff hours per resident, per day as compared to the national average.

Nursing Home Compare can provide a starting point for evaluating nursing homes and the level of care they provide. Careful research can be a powerful tool for safeguarding yourself or a loved one from nursing home abuse.

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