With more than 15,000 nursing homes in the United States, even a modest-size city is likely to have 20 or more within a short drive. How can a manageable list be sifted out of so many possibilities?
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The guiding principle is to balance practical considerations, such as distance and expense, with issues of quality, such as results of health and fire safety inspections. You can readily obtain quality-related information by mining such resources as the new U.S. News "America's Best Nursing Homes" rankings, which rely on information collected, analyzed, and converted into ratings by the federal Centers for Medicare and Medicaid Service (CMS). Some states also post data online.
You may find the thought of wading through data wholly unappealing, but the numbers have power well worth tapping. They will help you whittle down the nursing home universe to a short list of prospects and provide fodder for the types of questions to ask nursing home administrators when visiting the final candidates.
Make distance a priority. The best prescription for fending off depression and feelings of isolation in nursing home residents is to make sure they frequently see the significant people in their lives—adult children, of course, but also a neighbor dropping in for a meal or a grandchild coming to show off a good report card. Distance matters. "[A] facility that is a five-minute drive away may be best," says Phyllis Brostoff, president of the National Association of Professional Geriatric Caregivers, even if its marks are comparatively lower than those of another home an hour away. Close proximity also makes it easier to keep tabs on the quality of care a loved one is getting.
Work from the top down. Charlene Harrington, professor at the University of California, San Francisco, and an expert in long-term care, suggests searching for places rated by the federal government at four or five stars overall and eliminating lower-starred facilities. "You might end up having to keep the threes in there, but start with the top," she says. Consumer advocates are especially leery of a category of nursing homes labeled Special Focus Facilities by the government. Because of their history of poor performance, the 135 homes on the SFF list get twice the scrutiny that even one-star homes receive. But higher-ranking homes, she warns, are more likely to have a waiting list and may take only private payers. And while the star ratings are a good place to start, they cannot capture all of life's aggravating realities—such as having limited choices if you live in a thinly populated part of the country.
Count the nurses. The number of nurses and nurse aides is one of the best indicators of good care. An ample supply means they have the time to help your mother out of bed and into her slacks or nudge her to engage with peers. It means her array of blood pressure and pain medications is closely tracked and she is monitored for side effects, drug interactions, and overmedication. You can easily compare staffing at different homes because those that take Medicare or Medicaid residents must provide CMS with nurse staffing data, which is converted into the amount of nursing time per resident.
But the numbers should be used only as a rough guide: They reflect the average number of nurses and nurse assistants in the two-week period before the most recent health inspection survey. While the surveys are unannounced—and alerting a nursing home to the date of a coming inspection is a federal crime—administrators know that surveys are conducted at least every 15 months. If it's been 10 or 11 months since the last one, homes may staff up a bit more heavily in anticipation. Staffing information also is unaudited and its accuracy is suspect. Use the reported numbers to shape your short list, says Harrington, but draw conclusions only after visiting.