After evaluating nursing homes across the country, US News and World Report has named the Best Nursing Homes for 2018. More than 15,000 facilities were analyzed, and 2,975 nursing homes earned the top designation. Their findings are accessible online through the US News Nursing Home Finder.
Since 2009, US News has been providing these online ratings to help Americans make informed choices about nursing homes. The truth is, there is a wide range of quality in the industry, and no family wants to discover that they have entrusted their most vulnerable member to a dangerous nursing home.
To qualify as a “Best Nursing Home,” facilities had to provide consistently high-quality care to their long- and short-term patients. Understanding these ratings can illuminate key indicators of good nursing homes.
What Determines A Nursing Home’s Overall Rating
The US News rankings rely on public data provided by the Centers for Medicare and Medicaid Services (CMS). CMS is the federal agency tasked with overseeing nursing homes that accept Medicare, Medicaid, or both. Facilities that did not report data to CMS are not rated, but their location and basic information will still show up in the Nursing Home Finder.
If the home is eligible, then it is assigned an Overall Rating of “High-Performing,” “Better than Average,” “Average,” “Worse than Average,” or “Poor.” The ratings come from evaluations of both long- and short-term residents, and make use of data on health inspections, nurse staffing, and other quality measures tracked by CMS.
Health inspections are conducted every 12-to-15 months to locate deficiencies in areas such as sanitation, food preparation, infection control, and medication management. This is critical, as residents of nursing homes are especially vulnerable to disease and injury.
Even a minor infraction can have serious consequences. Residents are often on unfamiliar medications and, in some cases, have been hurt or even killed because of inattention to basic food safety or improper medication management. US News displays the results from all health and fire inspections on their Nursing Home Finder.
Nurse staffing also contributes to the rating. Proper staffing is essential to providing quality care, which seems obvious, but all too often nursing homes are severely understaffed. Unable to provide proper care to those in their charge, many facilities have engaged in fake reporting rather than actually fixing the problem.
US News looked at CMS payroll data to determine how much time nurses spend with each resident, taking into account the varied needs of each individual. In their annual ranking, they want to make sure that enough qualified nurses and staff are spending adequate time with patients on a daily basis.
What Is a Nursing Home’s ‘Short-Stay’ Rating?
For the first time this year, nursing homes received a Short-Stay rating in addition to an Overall rating. This is because there are typically 2 distinct populations who use nursing homes: long-term residents who need constant care, and short-term residents who need skilled nursing in order to recover. A facility that excels with long-term residents may be an improper fit for someone who needs therapy and rehabilitation before returning home. In all, there were only 736 nursing homes that were High Performing in both Overall and Short-Stay ratings, so the distinction is important.
Short-Stay ratings are determined by patients who spent 100 days or less in a nursing home. They look at the number and nature of rehospitalizations, resident complaints, process of care, and staffing. Is there an appropriate ratio of registered nurses to nursing staff? Is the staff stable, or constantly in flux? What are the frequency and severity of complaints? What percentage of residents newly receive antipsychotic medication? Answering questions like these help to determine whether or not a facility is delivering the therapy that short-term patients need.
Indicators and Signs of a Good Nursing Home
Appropriate staffing, positive health inspections, lack of complaints – these are all things to look for in the search for a good nursing home. As important as these ratings are, however, they are not intended to provide turn-key answers to people who are making a decision about a specific nursing home.
The quality of life for both the resident and their family is going to depend on external factors that numbers could never capture. For example, people need to make sure that the nursing home is in a realistic location. Long drives and rush-hour traffic make it harder for family and caregivers, and must be weighed alongside a facility’s rating.
The best way to research a nursing home is to visit it – ideally multiple times, at different times of the day – and talk to as many different people who work and live there as possible. Ask questions. This way, one can identify various red flags that signal bad news ahead.
The sad reality is that many American nursing homes are not the best. Most nursing homes are understaffed, and prospective residents and their family members need to be on their guard.