When a family member requires round-the-clock skilled nursing care, nursing homes are a logical choice. But how can you be sure your loved one will be safe? Concern about elder abuse in long-term care facilities is not unusual. According to the National Ombudsman Reporting System data, there were 14,258 complaints involving abuse, gross neglect, or exploitation at nursing homes in 2014. Elder abuse can have a host of negative effects on an individual including physical, psychological, financial, social, hospitalization and disability, and medical.
One resource for those researching long-term care for a family member is the U.S. News & World Report’s Best Nursing Homes listing. The much-viewed resource ranks more than 15,000 nursing homes across the country on criteria such as inspections, staffing and medical quality.
U.S. News has been rating nursing homes since 2009 using data from Nursing Home Compare, a program run by the Centers for Medicare & Medicaid Services (CMS), the federal agency that sets and enforces standards for nursing homes. CMS assigns a rating of one to five stars to each nursing home in each of three areas – state health inspections, nurse staffing, and medical quality, then provides an overall star-based rating for that facility.
Beginning with the 2018-2019 rating span, U.S. News will modify the way it evaluates CMS data by putting greater emphasis on staffing levels and quality measures. The decision to change its approach is based in part on experts who expressed to the media group that the CMS star rating overemphasized certain data points over others.
Here is a closer look at the criteria the Best Nursing Home listing relies on:
Almost all nursing homes in the country accept Medicare and/or Medicaid, and as a result, they are regulated by the federal government as well as the states in which they operate. State survey teams conduct inspections on behalf of CMS every 12 to 15 months to ensure each nursing home is meeting minimum quality and performance standards. These inspections also include investigations into complaints from residents, their family members or the public. CMS ratings in this area are based on deficiencies and their seriousness and scope, which translates into how many nursing home residents were or could have been affected by the deficiency.
Even facilities with the highest quality nurses and nurse aides cannot deliver quality care if there are not enough of them to care for the number of residents. Nursing homes are required to report the number of registered nurses, licensed practical nurses, licensed vocational nurses and certified nurse aids and assistants on the payroll as well as the number of hours they worked during the two weeks before the latest health inspection. That number is compared to the average number of residents at the facility during that same time period to determine the average number of daily minutes of nursing time each resident receives. Nursing homes that receive a five-star rating in this category provide about 4.5 hours of care a day to each resident, including 43 minutes from registered nurses.
Nursing homes are also required to submit clinical data for the latest three calendar quarters that detail the status of each resident according to 18 indicators, only half of which are used in CMS’ rating system. The process is complex but, in general, these indicators provide information on the percentage of residents who have had urinary tract infections, bedsores, or were physically restrained to prevent falls.
A word of caution – the Best Nursing Home listing shouldn’t be viewed as a definitive tool for choosing a nursing home. Personal visits offer the best insight into the quality of a nursing facility, providing family members and future residents an opportunity to ask questions, observe residents and their caregivers, and get a feel for the home that stars just cannot communicate.
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Beasley Allen lawyer Chris Boutwell is actively pursuing cases involving nursing home abuse and neglect. Long-term care facilities, including nursing homes, are rife with abuse and neglect and alarmingly high rates of under-reporting. To assist families and lawyers pursuing justice for victims, Chris has prepared a free brochure with information to help identify the signs of abuse and neglect, and advice about how to file a claim.
U.S. News & World Report