Greg Dill: Finding a good nursing home

One recent Sunday morning, I woke up to a text message from a coworker saying she’d been up all night with her mother in the emergency room.

Her mom had fallen, broken her hip, and was getting admitted to the hospital for surgery. As you can imagine, my colleague was exhausted, worried, and facing some important decisions. Even as her mom was being prepped for surgery, the hospital’s care coordinator was asking which rehabilitation facility she should be sent to afterwards.

As a fellow official of the U.S. Centers for Medicare & Medicaid Services (CMS), my associate has a better-than-average understanding of the healthcare system. But she’d never had to find a rehabilitation facility for a loved one. So she turned to an online tool CMS developed to help people find a suitable nursing home when they need one.

The tool is called Nursing Home Compare and you can find it on our www.Medicare.gov website. Just click on the button that says “Find nursing homes.” Enter your zip code or city and you can begin your search.

Nursing Home Compare assigns from one to five stars to every nursing facility that participates in Medicare or Medicaid, with five stars being the highest rating. These star ratings give you and your family an easy-to-understand summary of three important dimensions of nursing home quality: health inspection results, staffing information, and quality-of-care.

The goal of our Five-Star Quality Rating System is to help people distinguish between higher- and lower-performing nursing homes. CMS also wants to help nursing homes identify problem areas and to improve their quality.

Nursing facilities receive an overall star rating based on three types of performance indicators, each of which has its own star rating:

Health inspections: Nursing homes that participate in Medicare or Medicaid undergo unannounced, comprehensive inspections about once a year. CMS bases health inspection ratings on the number, scope, and severity of deficiencies found during the three most recent inspections, as well as on results of complaint investigations during the most recent 36 months.

Staffing levels: CMS bases staffing ratings on two components: 1) Registered nurse hours per resident day; and 2) total staffing hours (registered nurse plus licensed practical nurse plus nurse aide hours) per resident day. The staffing measures are adjusted for different levels of resident care needs.

Quality measures: These ratings are based on how a nursing home performs on 16 of the 24 quality-of-care measures currently posted on Nursing Home Compare. The measures reflect whether residents got flu shots, are in pain, or are losing weight. We also look at how well the facility controls pressure ulcers (bed sores), whether it overuses antipsychotic medications, and other indicators of how residents are treated.

A facility’s overall star rating is a composite of the ratings on the measures above. The core of the overall rating is the health inspection rating, which is adjusted up if the facility receives high staffing or quality-of-care ratings, or down if those ratings are low.

You can compare multiple facilities on Nursing Home Compare, as my colleague did when looking for the best spot for her mother. But keep in mind that star ratings are intended to be combined with other sources of information (such as a doctor’s recommendation) and shouldn’t substitute for visiting the nursing home in person. Indeed, after my coworker identified two possible facilities, she visited the one that had an available room and was pleased to learn it had high ratings for food service, something very important to her mother.

At www.Medicare.gov, you’ll also find “compare” websites for hospitals, home health services, dialysis facilities, medical equipment suppliers, and Medicare-approved health and prescription drug plans.

Choosing a nursing home for yourself or a loved one is a complex, personal, and often emotionally draining decision. With that in mind, we developed a detailed brochure, “Your Guide to Choosing a Nursing Home or Other Long-Term Care,” which you can find online at https://www.medicare.gov/Pubs/pdf/02174.pdf.

Among other things, the brochure provides a checklist of questions to ask nursing home managers, alternatives to nursing home care, and the legal rights and protections of nursing home residents.

I’m glad to report my colleague’s mother is on the mend!

Greg Dill is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).