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Mark A. Stein: With Medicare ratings in doubt, how to evaluate nursing homes

Mark A. Stein, on

Published in Home and Consumer News

Medicare created its five-star rating system for nursing homes to simplify the complicated process of choosing a facility and to provide peace of mind to families. Unfortunately, a recent investigation by the New York Times shows, some in the nursing home industry have been gaming the system in ways that could endanger patients.

I recommend you read the New York Times’ at-times gruesome reporting, and that you don’t take its warnings lightly.

Now, in spite of those findings, what can you do when the time comes to entrust a loved one to such a facility, whether for a limited rehabilitation after, say, a knee replacement, or a longer stay, if dementia has set in? Tales of helpless patients suffering from communicable diseases, dehydration, malnutrition, neglect and abuse make choosing a nursing home seem like a life-and-death decision.

Assessing a nursing home takes a lot of work

Hopefully, when you bought a home and car, helped your kids choose a college, and made other momentous life decisions, you did some deep digging. That is what’s required in choosing a nursing home now, given that confidence around the Medicare ratings has been shattered.

You’ll need to make use of the abundance of public records and other material available online, from inspection reports and ownership records to civil lawsuits and criminal complaints. Also, talk with friends and acquaintances who have family members already in nursing homes about the facilities they use and lessons they’ve learned.


And then, when you think you have found an exceptional facility or two, make time to personally visit each one — more than once, if possible — to see for yourself how patients feel they are treated, and to ask detailed questions of doctors, nurses, orderlies and administrators, not just the sales team. A booklet from the Centers for Medicare & Medicaid Services (yes, the very same agency that let its ratings be gamed), “Your Guide to Choosing a Nursing Home,” includes a list of issues to check on and questions to ask.

Do not wait until the last moment. Your inquiry could take weeks or longer and, prior to the pandemic, many top quality nursing homes had waiting lists.

Useful information from an independent news site

You might want to start at a public database called Nursing Home Inspect, from the nonprofit news outlet ProPublica. It ranks nursing homes by such metrics as the amount each one has paid in health and safety fines and the number of “serious deficiencies” that inspectors discovered on their premises. A deficiency, or violation, is considered serious if it puts one or more patients in “immediate jeopardy.”


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