6 Tips for Choosing a Good Nursing Home
1. Look at Staffing Levels
The Centers for Medicare and Medicaid Services (CMS), which regulates the nursing home industry, has staffing level requirements that nursing homes must follow to avoid fines or even the loss of their license. Unfortunately, the standards set by the government are pretty low, enforcement is weak, and nursing homes put profit over safety by cutting corners wherever possible. You might be surprised to discover that there aren’t many registered nurses in nursing homes, and their time is spread very thin. Most of the care provided at nursing home care is done by CNAs (certified nursing assistants) who are the lowest paid and lowest trained in all of health care, yet many nursing homes operate with far fewer staff members than they need. Under Maryland law, the ratio cannot be less than 1 CNA for every 25 residents at any given time, but you would be better served by a nursing home that has a much better ratio of CNAs per resident, if you can find one. The Long Term Care Community Coalition has published key staffing numbers, so you can measure and compare the level of care for nursing homes in your area. They show data on:
Name of State
Name of Nursing Home
MDS Census (number of residents in the facility)
Total Direct Care Staff Time
Average Staffing Hours Per Resident Per Day
Average RN Hours Per Resident Per Day
2. Get Their Rating on Nursing Home Compare
Medicare conducts regular inspections of nursing homes, and they share the results of these inspections, including violations they found and an overall 5-star rating on a website called Nursing Home Compare. The health inspection star rating is based on the nursing home’s three most recent regular inspections, as well as findings from inspections related to complaints and revisits over the past 3 years.
Nursing Home Compare also reports information about a nursing home’s health inspections, complaints files, and any resulting citations. Nursing homes that are certified by Medicare and Medicaid are inspected each year by professional health care inspectors who look for and report any health and safety violations.
3. Choose a Convenient Location
Don’t let your research take you too far from home. A nearby location that will encourage frequent visits from loved ones is perhaps more important than facility reputation. The more you and your family can visit, the safer and happier your loved one will be in a nursing home. Your presence will encourage stricter adherence to nursing home safety regulations, and your contact with your loved ones can help identify the signs of abuse and neglect early, so that you can intervene. You want to choose a nursing home that’s close to home or work, so that it is convenient for regular check ins. You cannot always be there to advocate for your loved one, so you might also want to check to see if cameras are permitted. That would enable you to keep an eye on your loved one remotely. That would be especially helpful now, because nursing homes have had to prohibit visitors to prevent the spread of COVID-19, and there is no indication when that restriction might be lifted.
4. Ask the Right Questions
Contact the nursing home and ask lots of questions. You’ll want to make sure the facility has services and experience to accommodate any special needs your loved one might have (e.g., dietary restrictions, mobility issues, dementia, etc.). Here are a few other questions you might want to ask.
How do you ensure infection control? COVID-19 has exposed how even the most highly rated nursing homes had terrible infection controls. Having solid infection controls is not only important for a pandemic-level virus. What many people do not know is that regular, run-of-the-mill seasonal flu is the number-one killer of nursing home residents, and the culprit is lax infection controls. Nursing homes should have an infection control point person and an infection control plan, including testing, a place for residents who need to be isolated due to infection, paid sick leave for infected staff, and ample supplies of personal protective equipment (PPE).
How do you prevent bed sores? Bed sores, also known as pressure ulcers, are a common problem at nursing homes, and there is no reason for them to occur other than negligence. A nursing home that cannot prevent bed sores is a nursing home with serious problems. Ask about their incidence of bed sores, and make sure they have the equipment and protocols to help people with mobility issues to avoid bed sores.
How do you prevent falls? Falls are another significant source of injury and death at nursing homes. The elderly are predisposed to falling, but there is much that nursing homes can do to prevent falls. Try to find out the incidence of falls at the nursing home, and what they do to prevent them. They should be assessing the resident for their fall risk, educating their staff on fall reduction methods (e.g., toileting routines to reduce nighttime bathroom trips), and creating a safe environment (e.g., reducing clutter, wet areas, poor lighting, etc.)
What is your protocol for providing mood-altering medications? Mood-altering medications should only be used as a last resort. Although nursing homes no longer use physical restraints on patients, they might resort to restraining them with drugs rather than providing adequate supervision. If the nursing home seems to be pretty flexible about giving these medications, it’s a red flag.
Does the facility have a resident or family council? These groups include family members and friends of residents who have organized to create a powerful united voice to advocate for the residents. The resident or family council works with nursing home administrators to ensure quality and solve problems.
5. Ask for References
When you have narrowed down your nursing homes to a few facilities, ask them to provide references. The quality of services and attention to detail (for better or worse) should be fairly consistent across all residents. Speak to the residents and families and prepare a list of questions. Some suggestions:
Is the resident happy?
What kinds of activities do they have to keep them engaged?
Does the resident have freedom of choice?
How much time do they get with staff and nurses?
Have you ever had a problem, and how well did the nursing home respond to it?
6. Check the Google Reviews
Simply Google the name of the facility and look at their Google Business listing (you might have to skip over some ads). The Google Business listing will have a star rating and reviews from customers. Read through the reviews, especially the negative ones. Pay attention to how the nursing home addresses the bad reviews. If they ignore it, that’s bad. If they remedy the issue, that’s good. Be leery of a nursing home with very few reviews.
Our attorneys at Brown & Barron, LLC focus on representing nursing home residents who have been neglected or abused. We know first-hand how these facilities function, and just how vulnerable residents are to injuries. If you believe you or a family member has suffered as a result of nursing home negligence, we invite you to contact our team as soon as possible to learn more about your rights and options.