How to Find the Best Nursing Home for Your Loved One

Q. We are looking for the right nursing home for my mother, but I’m having trouble knowing whether to trust the ratings I see online on the federal government’s Nursing Home Compare website. For instance, there’s a nursing home close to my house that would be convenient, but the ratings are perplexing.

Nine reviewers have given the place both laudatory five-star ratings and outraged one-star complaints. Overall, the place got an average of three stars.

To me, this seems to be a highly-flawed measurement. Can I really trust nine reviewers for a 300-plus-bed facility? What I’m asking is if the five-star ratings on the Nursing Home Compare website are trustworthy, or if we should go to Yelp or similar sites to find out what consumers really think. Or are there other ways we can determine which nursing home is best for our mother? Thanks for your help!

A. Nursing home care is often the best choice for aging family members who can no longer live on their own. On any given morning this year in the U.S., roughly 1.4 million individuals, including 1 in 10 individuals age 85 and above, will wake up in a nursing home. Of course, for our loved ones, we want the best possible facility, but as you inquired, what ratings can we really trust to guide us in the right direction?

Twenty years ago, Nursing Home Compare made its online debut. The site added the starred ranking system in 2009, after a senator complained at a congressional hearing that it was easier to shop for a washing machine than a nursing home.

The Nursing Home Compare website contains lots of information about nursing homes, such as hours of staff time per resident per day, deficiencies discovered during the most recent inspections, and how many residents have bedsores and other indications of poor care. This year, the federal Centers for Medicare and Medicaid Services anticipate that the tool will be used 2.4 million times.

The CMS Nursing Home Compare tool is extremely helpful, but may not be 100% reliable in all aspects. Here’s why: The on-site inspections, which Medicare requires every 12 to 15 months, constitute a key component of the ratings. But the two other categories contributing to the ratings — staffing and quality measures — have historically been reported by the homes themselves.  However, to address at least one of these concerns, CMS is now using payroll-based data on Nursing Home Compare. However, even this may be slightly unreliable, because CMS includes nurses assigned to non-care functions in their computations of staffing levels. So to supplement the staffing information on Nursing Home Compare, you should also visit the website of the nonprofit Long Term Care Community Coalition at https://nursinghome411.org. The nursing staff data provided on this website does not include staff time designated for administrative or non-care functions; it only includes the staff that nursing homes have designated as providing hands-on resident care.

Using Yelp to Find a Nursing Home?

Researchers at the University of Southern California believe Yelp can be another useful tool (in collaboration with other tools and visits) in helping prospective residents or their family members make decisions about facilities, the New York Times reported.

Though reviews posted on Yelp and other online platforms such as Google and Caring.com are not perfect and are also not 100% reliable, the issue is that Medicare’s Nursing Home Compare website is not completely reliable, said Dr. Rahman.

Dr. Rahman and colleagues examined 51 Yelp-rated nursing homes in California and found that most reviews commented on factors such as staff attitude and responsiveness, but rarely mentioned safety concerns or health care quality. In an earlier study, they found the Yelp rankings correlated only weakly to Nursing Home Compare’s star ratings. Rahman noted that Nursing Home Compare does not currently include consumer feedback, where Yelp (and other consumer review sites) obviously exclusively provide consumer feedback.

However, a potential problem with Yelp and other consumer review sites, when it comes to nursing home ratings, is that people with a loved one in a nursing home are usually not happy about the fact that their loved one has to be in a nursing home, and the families of nursing home residents often have unrealistic expectations of what nursing home care should look like, so you often have unhappy people with unrealistic expectations posting reviews on these sites, which are almost always going to result in nursing homes having much lower ratings on these sites than they do on the nursing home compare site which contains mostly objective data, other than the two areas noted above

The Answer: Use as Many Sources as Possible and Make a Few Visits!

The best thing you can do if you are looking for a nursing home for a loved one is to use as many sources as possible. Always start with Nursing Home Compare (just Google the term “NH compare” and it will be the first link that appears in the results), as this is the only official website that will tell you whether the nursing home accepts Medicaid, which is one of the most important factors you need to know before choosing a nursing home (don’t ever ask a nursing home to tell you whether it accepts Medicaid, because almost all nursing homes do, but some tell prospective applicants that they don’t; also, asking about Medicaid will tip off the nursing home admissions person that you are thinking about Medicaid, which may cause the nursing home to turn you away because they would rather not take a family that is thinking about Medicaid because nursing homes don’t make as much money on Medicaid residents). Knowing in advance from nursing home compare that the facility accepts Medicaid is important because most people at some point run out of money paying for nursing home care and need to go on Medicaid. Even better than simply paying the nursing home until you run out of money is hiring a Certified Elder Law Attorney, such as myself. We guarantee for our clients that can protect 100% of the assets of a married couple, and 40% to 70% of the assets of a single person, and get our clients on Medicaid.

If you are searching for a specific nursing and cannot find it on Nursing Home Compare, then you may want to avoid that facility completely, because this means either: (1) the facility is not a nursing home, but rather an assisted living facility, or (2) it is a nursing home that does not accept either Medicare or Medicaid, which is typically because they do not meet the federal government’s basic standards for care, and they do not undergo the annual inspections by CMS that all the other nursing homes have to go through.

After you have a narrowed down your search using Nursing Home Compare, then take a look at reviews on consumer websites such as Yelp and Google and caring.com.

Once you have created a short list of potential nursing homes in your desired location, be sure to trust your own insight by visiting these nursing homes to help find the best one to meet your needs. When you’re ready to visit in person, ask yourself some important questions such as Is the location realistic? Lengthy drives will affect visits and add barriers to relationships with friends and family members.

Then, turn to administrators, staff members, residents, and the family members of residents for answers to other important questions. Simply download my Nursing Home Evaluation Tool, from my best selling book, the Nursing Home Survival Guide, to help you ask all the right questions to all the right people. Better yet, order the entire book here, which is chock full of tons of other valuable information to help you in your search for a good nursing home.

Planning for Nursing Home Care

When it comes to finding the right nursing home for a loved one, a big concern for most families is the affordability of nursing home care. This is a legitimate concern, as nursing homes in the Metro DC Area cost $10,000-14,000 a month. To protect your family’s hard-earned assets from these catastrophic costs, there is no time like the present to begin Medicaid Asset Protection Planning. Please call us to make an appointment for a no-cost initial consultation to discuss your options:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797

P.S. Similar to a nursing home, families are looking for the best elder law and estate planning law firm to meet their needs. Are you a current or past client who is happy with our services, or simply a long-time reader of our newsletter? If you use Yelp or Google, please leave a review about the Farr Law Firm or about our newsletter, to help others find us! Thanks in advance!

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