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Are Ratings Helpful When Selecting A Nursing Home?

Woman sitting on a wheelchair

When you need to find a nursing home for yourself or a loved one, it is only natural to begin by searching out the ratings for local residential facilities. A simple internet search will net you ratings from Medicare, state health agencies, and independent ratings from “unbiased” sources, like news organizations. These ratings are helpful when selecting a nursing home but may not be as reliable as you would think.

Consider the Classification of Residential Facilities When Selecting a Nursing Home

To understand the rating systems in nursing homes and residential facilities, you have to consider the different types of nursing homes. Nursing homes provide 24-hour care that may be short-term or long-term.

Short-term care is for people needing rehabilitation services such as physical therapy following a surgical procedure such as a knee replacement. People needing skilled nursing care following an illness may also use a short-term facility.

Long-term care is for those needing assistance with daily tasks that can no longer live and care for themselves. These facilities may cater to specific patients, such as those with Alzheimer’s disease or other forms of dementia. Others may handle patients with physical needs due to disabilities.

Understanding Nursing Home Ratings

Official nursing home ratings come from state health inspections. Nursing homes with high ratings earn five stars, while those scoring lower may only make one- or two-star ratings.

State inspectors may visit each nursing home yearly for unannounced inspections or to respond to a complaint lodged against the facility. During inspections, they review medical records and may do patient visits with aides or nurses over the course of several days. They investigate staffing levels to determine if there are enough people working to meet the needs of residents. Inspectors may examine the food produced for patients in onsite kitchens. Inspectors may interview staff and residents during an inspection.

At the end of an inspection period, ratings are assigned to the facility based on the inspector’s identified problems, the number and frequency of violations, and the occurrence of very serious violations.

How Inspectors Document  Violations in Nursing Homes

During an inspection, the inspector will propose issuing a citation if violations are noted. The inspector must build a case by compiling witness statements, medical records, and additional evidence.

The process is generally reviewed and approved by the inspector’s supervisor to ensure that the investigation is thorough and that the documentation is in order. Violations are used to compile a star rating, with more significant violations impacting the rating. The nursing home has a process to challenge its rating, a process that has been criticized for being too easy on nursing homes and lacking transparency.

Minor violations may be ignored during the inspection or corrected immediately and never documented. When violations place residents in “immediate jeopardy” or in danger of harm, the documentation process is included in the nursing home listing. Prior reports are available for review and will show a pattern if a facility receives similar citations over a period of time.

How Reporting Discrepancies Affect Ratings

The U.S. Centers for Medicare and Medicaid Services (CMS) sends a team of its own inspectors to approximately five percent of nursing homes. Their goal is to verify that state inspectors are performing an adequate job and are consistent in their reporting.

Although the federal inspectors often find more severe issues, the agency doesn’t publish their results, so they are not factored into the star ratings. The Government Accountability Office (GAO) reports on inconsistencies in documentation, including failure to document some severe problems.

Should You Trust Ratings on Medicare Care Compare?

When searching for a nursing home, relying solely on the Care Compare site provided by the CMS may not reveal problems with a prospective residential facility. Reviewing the rating changes over the years may reveal an evident pattern. It may also display five-star ratings that belie the accurate picture.

Some nursing homes are privately-owned, for-profit facilities. They rely on the profitability created by having higher star ratings. The facilities may look good on paper but may be less desirable in real life.

The Reliability of Independent Rating Agencies for Nursing Homes

In addition to the government providing star ratings, independent agencies also rate nursing homes. It is always a good idea to check multiple reviewing agencies to compare the ratings as the criteria vary.

Even though a nursing home may have the highest ratings across several scales, it does not guarantee that it is a quality facility. Ratings can be helpful as a starting point, but they are not a substitute for in-person evaluations. According to the Administration for Community Living (ALC), the degree and length of care necessary for each individual can vary significantly based on age and overall health.

Making the Best Choice of Nursing Home for Your Loved One

When deciding on a short- or long-term care facility for yourself or a loved one, please consider the following during your evaluation:

  • Staff-to-resident ratio
  • COVID infection rates and deaths at the facility
  • Staff turnover rates, especially among management
  • Check the activity level of patients (are there scheduled activities)
  • Ensure compliance with federal regulations for care
  • Do nurses and aides answer patient needs promptly?
  • Is there an odor of urine or feces in the facility?
  • Does the staff treat patients and family members with respect?
  • Is the surrounding neighborhood safe?
  • Are patients alert, or do they seem over-medicated?
  • Are the patient rooms clean and personalized?
  • Is food being served to patients nutritious and appealing?

It is a good idea to keep a list of questions to ask during a nursing home visit. This can contain everything you wish to ask staff during your “interview” with the facility. Keeping notes will assist you in making an informed decision.

Brown & Barron Can Help With Your Nursing Home Abuse and Neglect Case

The nursing home abuse and neglect attorneys at Brown & Barron can help you seek justice for your loved one. If you suspect nursing home abuse or neglect or are concerned about how a facility treats your loved one, don’t hesitate to contact our office for a free case evaluation. Our attorneys can examine your situation to determine if a care facility has been abusive or neglectful. Call us today!

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