How to screen for quality care when searching for the right nursing home

After a stay in the hospital, most people would prefer to go home to recuperate. But that may not be possible.

If a loved one needs more medical care, rehabilitation or supervision, you’ll have to find a nursing home or skilled nursing facility before the patient is discharged from the hospital.

But what should you look for, and who is a good source of impartial information? Nursing homes are a business with marketing personnel whose job it is to sell you on the place. But you need more than glossy brochures and vague promises to go on. Because many nursing homes didn’t fare well during the pandemic, you should be especially vigilant in your search now.

Nursing homes often specialize in areas of care, like stroke recovery or long-term ventilator support, so ask the hospitalist assigned to your case, as well as your family physician, about the kind of care your loved one will need. A geriatric care manager can often recommend facilities and coordinate the transition from hospital to nursing home.

Whether you have names of places you want to check out or are starting from scratch, kick off your search at Care Compare (medicare.gov/care-compare) for nursing homes certified by Medicare and Medicaid, which most are. Facilities are rated for overall care with one to five stars, from lowest to highest quality, based on health inspections, staffing levels and evaluation measures.

Search by facility name or location, and filter the results for those rated with four or five stars. If few options turn up, expand your search geographically and include three-star facilities, which are considered average. Avoid one- or two-star facilities and those that are “special focus facility” candidates or have already been designated that way, as they have been cited for serious deficiencies or problems over multiple years and need additional oversight.

Next, filter your results for nursing homes rated four or five stars for their staffing of nurses and aides. This represents the level of care that residents receive, such as the number of services they get, how long they must wait for them and the amount of time that the staff spends attending to each person, says Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care.

Care Compare isn’t perfect; nursing homes self-report the information, and their data is prone to inflation and manipulation. But the Centers for Medicare & Medicaid Services, which manages the tool, has improved its accuracy over the past several years by basing data on verifiable sources, such as staffing levels from payroll data.

Every state has an office of ombudsman for long-term care that fields and resolves complaints about nursing homes and other care facilities. To find your state or local ombudsman, visit theconsumervoice.org/get_help.

State survey reports are another resource. To be certified by Medicare and Medicaid, facilities must show they comply substantially with federal and state requirements. The report lists deficiencies cited and enforcement actions taken, with up to three years of survey reports accessible on Care Compare. Nursing homes and your state’s department of health should also make the reports available.

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