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How Reliable Are Nursing Home Ratings?

How Reliable Are Nursing Home Ratings?

Choosing the Right Nursing Home

[Ed. Note: We first wrote about the New York Times investigation on nursing home ratings on March 26th. You can find that post here. Since then, we have heard from several readers seeking more information and wanting to know what they should do when trying to find the ideal nursing home for a loved one. We have expanded our post, discuss the steps to find the best nursing home and even added a bonus section on questions to ask when interviewing nursing home admissions staff. Thank you for the questions and comments!]

Finding the right nursing home for a loved one is a difficult task. For many, the only tools available are online ratings and a visit to the facility. While onsite visits are important, they don’t help much in determining whether a facility has good training for staff, proper infectious disease controls and a long history of no complaints.

That leaves online reviews.

Unfortunately, online reviews are easily manipulated. Last year we wrote a series of articles about the worst nursing homes in each state. Although somewhat subjective, our review was largely based on ratings from Medicare. They have the tools to “go behind the curtain” and inspect facilities, examine staffing and monitor patient complaints.

While Medicare’s online nursing home tool remains our favorite, there are many other online ratings. What was interesting to us is how some of the worst nursing homes (according to Medicare) still manages to get great online reviews. Often, the facility just creates phony email accounts and has staff ghostwrite glowing reviews.

Medicare’s own compare tool remains our favorite and what we believe is the least biased tool. It isn’t free from errors, however.

A recent New York Times investigation suggests that even Medicare’s reviews are often plagued with errors. Since the beginning of the  COVID-19 pandemic, over 130,000 people have died in nursing homes because of coronavirus. Those deaths were largely preventable. That makes finding the right nursing home even more important.

Here is what the New York Times found:

  • “Much of the information submitted to C.M.S. is wrong. Almost always, that incorrect information makes the homes seem cleaner and safer than they are. [CMS is the Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare.]
  • “Some nursing homes inflate their staffing levels by, for example, including employees who are on vacation. The number of patients on dangerous antipsychotic medications is frequently understated. Residents’ accidents and health problems often go unreported. [Our own investigation found nursing homes that count off premise administrators and on call workers as being on duty and in the facility providing patient care. If you plan to visit a nursing home as part of your own due diligence research, go on a holiday or weekend when staffing levels are often at their worst.]
  • “In one sign of the problems with the self-reported data, nursing homes that earn five stars for their quality of care are nearly as likely to flunk in-person inspections as to ace them. But the government rarely audits the nursing homes’ data.
  • “Data suggest that at least some nursing homes know in advance about what are supposed to be surprise inspections. Health inspectors still routinely found problems with abuse and neglect at five-star facilities, yet they rarely deemed the infractions serious enough to merit lower ratings.” [COVID patient safety protocols made surprise visits much more difficult. Now facilities often know when an inspector is coming.]

How Do You Find the Best Nursing Home?

Despite problems in online ratings, Medicare’s Care Compare remains the best online rating system. While a five star rating doesn’t mean that a nursing home doesn’t have big problems, in our experience the facilities with one or two stars (or worse) almost always have problems.

Other online ratings should be consulted as well but realize it is easy to fudge online ratings.

We recommend a visit to the facility. Both one that is planned and one on a weekend evening or holiday. Until recently, surprise visits were an impossibility because of COVID-19 restrictions. Fortunately, in many states visiting policies are opening up.

Third, talk with your loved one’s physician. Often, they know the good and the bad nursing homes in the area.

Finally, visit your loved one often. Obviously, it is important for your loved one to have that family connection. There is a secondary benefit, however. Facilities know the patients that receive visitors and those that don’t. Typically patients who have actively visiting families get better care.

Nursing Home Neglect Lawyers

No matter their age or mental ability, nursing home residents are human beings with rights. Bed sores, COVID-19, abuse, falls, medication mishaps -- all of these things are easily prevented with good policies, proper training, and staff who care about following the rules. It is therefore critical to do as much due diligence as possible when selecting a nursing home for a loved one.

To learn more about what you can do about nursing home abuse and neglect, contact us.

Consultations are always free, without obligation and confidential. Please contact us online, by email [hidden email] or call us at 833-201-1555 to set up a time to talk. We or someone in our network will respond immediately. 

Bonus Section – Questions You Should Ask When Selecting a Nursing Home

So you have done your online research and are now planning to visit several facilities. What questions should you be asking? Here is our list of questions.

  1. If your loved one is receiving Medicare and plans to pay with Medicare, it is pretty much a given that the facility is certified by Medicare (CMS). But if you are using private funds, ask if the facility is Medicare certified. Those that are go through a rigorous review process.
  2. Does the facility have specialty care areas such as memory care (Alzheimer’s unit)? If so, are those patients physically segregated from the general population?
  3. What bathroom and bathing facilities are available? (One resident per bathroom? Two? Four?)
  4. What assistance is available for bathing and toileting? (Even if your loved one doesn’t need help now, it’s good to know how the facility handles these activities.)
  5. What are the staffing ratios? (RN’s, LPN’s and CNA’s) What are the staffing rations on nights, weekend and holidays?
  6. How are prescription drugs handled and billed?
  7. What types of activities are available for residents?
  8. Is there a safe outdoor area for residents?
  9. Is there a commissary with items such as shaving cream and magazines on premises? If not, how are these needs handled?
  10. How often are individual care plans reviewed?
  11. How often is a physician on premises? What are her qualifications?
  12. If a shared room, what is the process for selecting a new roommate if dissatisfied?
  13. Is there a library with large print or audio books?
  14. Is there a social worker or mental health professional on staff?
  15. How are meals served? In a communal dining room? In room? (Take a look at the meals being served while visiting!)
  16. Ask about staff turnover and background checks.
  17. How is laundry handled? How often are bed linens changed?
  18. How are extra services billed?
  19. What are visitation policies? (This has become extremely important since the pandemic began)


Related topics: neglect (68) | nursing home abuse (52) | nursing home abuse lawyers (43) | nursing home neglect (60) | poor staffing (24) | substandard care (67)

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