By Ross Blair
Chances are, at some point you or a loved one may need to spend time in a nursing home.
In fact, about 70 percent of Americans will need a form of long-term care at some point in their lives. As more baby boomers continue to turn 65 — seniors are expected to comprise 19 percent of the population by 2030 — a growing number of people will be looking for the right place to receive the care and services they need.
Long-term care refers to a range of services and support you may need over a long period of time. Most long-term care is not medical care; rather it involves receiving some outside assistance with the tasks of everyday life. Examples include bathing, dressing, using the toilet, moving from different rooms and eating.
Medicare will pay for up to 100 days in a skilled nursing facility and any medically necessary home health care, but the program does not have a long-term care benefit. Certain care providers, such as nursing homes and assisted living facilities offering custodial care (help with tasks of everyday life), must be paid for independently. (Learn how you can use a life insurance policy to pay for long-term care.)
How to Measure Nursing Home Care Quality
The cost of (and demand for) nursing home care is rising, which means that elders and their caregivers need to start planning ahead. There are about 16,000 nursing homes in the United States. Where do you start?
It's important to compare the care that different nursing homes provide to find the facility that best suits your needs. You can compare nursing home quality at Nursing Home Compare, a website managed by the Centers for Medicare & Medicaid Services (CMS). Nursing Home Compare contains quality of care information for every Medicare-and Medicaid-certified nursing home in the country.
Entering your ZIP code will give you three factors with which to compare the different nursing homes in your area.
Medicare's Rating System for Nursing Homes
Medicare's nursing home ratings come from three categories: staffing, health inspections and quality measures. Each of these is described in more detail below. A rating, ranging from one to five stars, is provided for each category, allowing you to look more closely at the areas that are most important to you. In addition, all three ratings are combined to calculate an overall rate. The more stars a facility receives, the higher the quality. Three stars indicate a facility is average in quality when compared to other nursing homes in that state.
- Nursing home staff numbers: By law, nursing homes must provide enough staff to adequately care for residents. However, there isn't a federal standard that dictates the ideal number of staff members a facility should have. The staffing measure shows the number of staff hours per resident, per day. It includes information on registered nurses; licensed practical nurses and licensed vocational nurses; certified nursing assistants; and physical therapists. The rating also takes into consideration that some residents need more care. For example, a nursing home with residents who have severe needs would be expected to employ more nursing staff than a facility with residents who are healthier or who require less skilled nursing care.
- Detailed health inspection information: The health inspection score contains information from the last three years of onsite inspections, including both standard (usually annual) visits and investigations triggered by complaints. During a visit, inspectors note the extent to which a nursing home meets Medicare's quality requirements, which range from properly managing medications and prescriptions to how staff and residents interact with each other. Nursing homes with more frequent, serious violations receive lower ratings than homes with less severe, isolated issues. You can see how individual nursing homes compare to facilities statewide and nationally, as well as read the latest inspection reports.
- Quality measures: The quality measures rating has information on nine different physical and clinical measures for nursing home residents. These include, for example, the prevalence of pressure sores, changes to residents' mobility and the percentage of residents who receive flu shots. The measures—which are broken out by short- and long-term residents—offer information about how well nursing homes are taking care of their residents.
Nursing Home Compare can be an invaluable source of information for caregivers and their elderly loved ones. However, it's best to consider this a supplemental resource to be used in conjunction with the other information you gather about nursing home facilities. If possible, it's a good idea to visit nursing homes in person and bring along a list of questions you'd like answered.
Many of us don't like to think about getting older; but thinking ahead and researching your options will help you find the nursing facility that is right for you or your loved one.