MSN had a story about U.S. News & World Report’s issue on the Best Nursing Homes.

3.3 million Americans move into a nursing home each year.  One in seven Americans age 65 and older will spend time in one of the nation’s 16,000 nursing homes this year and for those 85 and older, the chances are more than one in five. Finding one that provides quality care is a challenge. Best Nursing Homes highlights meaningful data, like what proportion of residents have bedsores or are in pain.  Be leery of nursing homes that the government has labeled Special Focus Facilities. In Best Nursing Homes, facilities in this category are flagged with an icon that indicates they’ve been singled out by the state where they operate and by CMS as nursing homes with long histories of subpar or inconsistent health inspections.

The U.S. News rankings are built on data from Nursing Home Compare, a consumer web site run by the federal Centers for Medicare and Medicaid Services. CMS sets and enforces standards for all nursing homes enrolled in Medicare or Medicaid.  The data for Nursing Home Compare come from regular health inspections carried out by state agencies and from the homes themselves. Based onthat information, CMS assigns an overall ratings of one to five stars to all nursing homes other than a few too new for meaningful data to be available. Homes are also given one to five stars in how well they do in the health inspections, in providing enough nurses, and providing a high level of quality of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code.

Here are more details about the CMS standards that determine a home’s rating:

Health inspections

Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months.  Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents’ rights and quality of life, and proper skin care. A home’s rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame.

Nurse staffing

Even first-rate nursing care falls short if there isn’t enough of it because of too few nurses who can spend time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. To receive five stars in the latest CMS ratings, nurses and aides had to provide slightly more than four hours of care a day to each resident, including 33 minutes from registered nurses. The time provided by each home is shown in the rankings.

Quality measures

CMS requires nursing homes have to submit clinical data for the most recent three quarters detailing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair.


USA Today reported that more than 560 of the nation’s nursing homes have not improved care for the past three years from a one-star federal government rating — the lowest on a five-star scale — even though most homes improved, according to a USA TODAY analysis of federal data.  See ratings for nursing homes.

The lowest overall rating is awarded to homes "much below average" compared with others in their state, according to CMS.   The star ratings are part of a broader federal effort to increase transparency for consumers of health care.  The federal government contracts with states to inspect nursing homes about once a year. The star ratings combine scores of data points, including information from annual inspections, quality measures and staff time spent with residents.

USA TODAY analyzed the ratings for 15,700 nursing homes for the past three years. Among the findings:

•Some homes are stuck at the bottom: 564 homes — representing 77,315 beds — received one star in each of seven reporting periods analyzed over three years. But 448 homes received the best overall rating — five stars — during each period.

Among the consistently low performers, almost two-thirds were for-profit nursing homes that are owned by chains. That’s a higher share than the 40% of all nursing homes in for-profit chains.

Lower staff turnover can create better care because employees become familiar with the routines and needs of nursing home residents.



Gov. Arnold Schwarzenegger signed into law two bills that increases transparency requirements for nursing homes in California.  Both bills confront the failing quality of care in nursing homes created by the lack of transparency in the ownership and management structure of these facilities. 

State law (A.B. 1457) will require licensees of a nursing home or skilled nursing facility to disclose the name and contact information of the person accountable for both patient care and facility operations with each abbreviated admissions contract.  The law also requires a facility issue a written notification to residents and their primary contacts in the event the facility changes ownership.

The California Department of Public Health indicates that from January 1, 2007 through December 31, 2008, it received 135 Skilled Nursing Facilities change of ownership applications, and it approved 115. "Nursing home abuse and neglect continues to be a serious problem in the United States.  According to a report conducted by the Inspector General of the Department of Health and Human Services, 94 percent of all for-profit nursing homes were cited in 2007 for violations of federal health and safety standards," said Assemblyman Mike Davis (D-Los Angeles), author of AB 1457.  Davis contends that the new law’s notification requirements "will help ensure quality care in nursing homes." California is home to roughly 1,200 nursing homes, more than any other state in the country, according to the California Health Care Foundation.

According to the California Health Care Foundation, California has more Long Term Care (LTC) providers than any other state: some 1,200 nursing homes, 14,000 residential care settings with varying levels of care, and a vast array of community-based services.

The Governor also signed legislation (A.B. 215) requiring California nursing homes to post their five-star rating issued by the Federal Government’s Centers for Medicare and Medicaid Services. The rating, with five stars being the highest and one star the lowest, includes medical care, staffing levels, food services, sanitation, bedsore mitigation and the results of licensing inspections.


"The nursing home grading system will provide families vital information about the quality of care for their loved ones as the County’s successful Restaurant Grading system equips them to make informed decisions about dining establishments," said Supervisor Michael D. Antonovich. "It also provides incentives for facilities to establish higher quality standards and compliance."






Worcester Telegram & Gazette News had a great article discussing the deficiencies in nursing homes in Massachusetts although this article could have been written about any state.  

The article states that local nursing homes have been reprimanded in recent years for physical and sexual abuse, neglect and other serious mistreatment of elderly residents, according to state reports.   The deficiencies range from minor to serious including cold food to filthy bathrooms to violations of patient rights, medication errors and preventable falls in at least three patient deaths over the last three years.

A Telegram & Gazette review and analysis of hundreds of pages of state and federal inspection reports on the region’s nursing homes as well as summaries of state investigations prompted by patient and family complaints found:

• The state Department of Public Health rated 14 area nursing homes — more than 20 percent of the region’s 62 facilities — among the worst in the state as of November. Three of those were rated in the bottom 4 percent statewide, and four others in the bottom 6 percent.

• Federal regulators have fined 21 area nursing homes a total of more than $150,000 for serious and repeated violations of Medicaid regulations since 2005.

• The quality of local nursing homes varies widely from several that scored perfect or nearly so in state inspections to a handful of problem facilities whose scores are among the lowest in the region and that have been investigated repeatedly. The latter often were cited for poor care, in response to complaints from patients and their families.

Among those complaints, state inspectors validated at least five local cases of physical abuse and 10 cases of neglect over the last three years.

Among the scores of complaints lodged against area nursing homes and substantiated by state investigators were a number of claims of physical abuse.

Radius Healthcare of Southbridge, a for-profit nursing home licensed for 144 beds, was cited for physical abuse of residents in February 2006 and again in December 2006, according to investigation summaries. Third and fourth complaints of physical abuse in April and October were also investigated.

During an annual inspection in February 2008, the state surveyor reported residents whose wheelchairs would not fit under dining room tables, forcing the elderly patients to hold drinks and food in shaking hands for long periods. One resident of the nursing home also went more than eight months without seeing the facility doctor, according to the inspection report.

Medicaid reimburses nursing homes an average of $180 a day per patient in Massachusetts.  The state nursing home trade association puts the average retail price of care for those paying out of pocket at $270 a day, or more than $98,000 a year.

An advocacy group pushing for higher-quality nursing home care in the state, Massachusetts Advocates for Nursing Home Reform, maintains that a complete overhaul of the system is needed. The group is calling on the industry to move away from what it calls a “hospital-like model.”