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How to Choose a Nursing Home
What to Look for…How to Choose a Facility
Choosing a nursing home for a family member is one of the most difficult decisions in life. It is a stressful, time–consuming task that is often made worse by the fact that a loved one has suffered a medical crisis. You may face great pressure to locate a nursing home and arrange care in a very short period of time.
Fortunately, there are time–tested methods for identifying and evaluating nursing homes. Some important factors to consider include the location of the home, its participation in the Medicare and Medi–Cal programs, its compliance with public standards, and whether its services meet your needs and desires.
Medicare and Medi–Cal Considerations
If you want Medicare or Medi–Cal to help pay for the nursing home care, you must select a facility that is certified by these programs. Due to the extremely high cost of nursing home care – which averages well above $200 per day – few people can afford to pay privately for very long. Most California nursing homes participate in both Medicare and Medi–Cal.
Medicare’s short–term skilled nursing facility benefit is very limited, but is often helpful to gain admission to a nursing home, especially when skilled nursing care or therapy are needed after hospitalization due to a stroke, surgery, injury or other medical conditions. Medicare covers up to 100 days of skilled nursing care following a hospital stay of at least three days.
Medi–Cal helps pay nursing home care for two–of–every–three residents in California. Due to the high cost of nursing home care, most people in nursing home’s will meet Medi–Cal’s financial eligibility requirements sometime during their stay. CANHR’s website provides extensive information on Medi–Cal eligibility for nursing home care.
Even if you don’t need or qualify for Medi–Cal now, it is best to select a Medi–Cal certified facility. Uncertified facilities can evict you when your money and insurance runs out. Your choice of other facilities at that point may be very limited. Medi–Cal certified facilities cannot evict residents who qualify for Medi–Cal during their stay.
Although it is illegal for a certified nursing home to require a resident to pay privately for any set period of time, many nursing homes give preference to applicants who can pay privately. The longer you can pay the private rate, the more options you will have when looking for a facility.
It is important to select a nursing home that is close and convenient to the person(s) who will be visiting the resident most often. Residents who have frequent visitors often recover faster, are happier and healthier from the love and attention received and tend to receive a higher quality of care. When family members and friends are close enough to visit frequently, they can monitor the resident’s condition, participate in care planning and respond quickly to emergencies.
Always seek a nursing home that can meet any special care needs your loved one may have. For example, some residents need specialized respiratory care, such as a ventilator, that is only available at certain facilities. Or someone with dementia may need extra supervision and assistance with daily needs. Ask detailed questions to make sure facilities under consideration are currently able to provide the necessary care.
If possible, seek information about facilities under consideration from people you trust. Relatives, friends, clergy, local senior groups, ombudsman programs, Alzheimer’s support groups, hospital discharge planners, doctors and others may have recent experiences with nursing homes in your area. You can also seek opinions from residents and visitors while making visits to check on nursing homes.
It’s a good idea to check the inspection history of any facility that you are considering. The California Department of Public Health (CDPH) conducts inspections and complaint investigations of nursing homes in California. Its Cal Health Find website provides information on every licensed nursing home, including Medicare and Medi-Cal status, and the recent history of complaints, deficiencies (violations) and citations (financial penalties).
It is best to avoid nursing homes that have many complaints, deficiencies or citations. For complaints, consider all complaints that have been filed against a nursing home, not just those that CDPH has substantiated. CDPH only substantiates a small percentage of complaints due to serious problems with its investigation system.
ProPublica’s Nursing Home Inspect site also provides access to nursing home inspection histories, with advanced search features.
Nursing Home Ratings
Many people consult online nursing home rating systems when selecting a nursing home. The most popular sites are Nursing Home Compare (operated by Medicare) and CalQualityCare (managed by the University of California, San Francisco and the Institute for Health and Aging).
Although the ratings have serious limitations, they can be useful in narrowing your choice. It is almost always best to avoid lower rated nursing homes if you can.
However, nursing home ratings are not reliable in identifying high quality facilities because they are largely based on inspection findings that often overlook or understate serious problems. The quality of California’s nursing home inspection system is poor, at best. Adding to this problem, Nursing Home Compare’s ratings do not take into account any violations of California nursing home standards or California citations issued to nursing homes.
Another flaw in the federal rating system is its reliance on staffing and quality data that are self-reported by nursing homes. Nursing homes are able to game the rating system because this data is not audited.
You cannot rely on ratings alone to find a good nursing home.
Yelp and Other Web-Based Reviews
A growing number of nursing homes are reviewed on Yelp and other web-based review sites. Reviews offered on these sites offer a much more individualized perspective on the quality of care and the treatment of residents. Use your best judgement when considering online reviews to determine if they appear to be trustworthy. Some nursing homes arrange for fake reviews, so beware of comments that seem unreliable or too good to be true.
Nothing substitutes for a personal visit to the facility. Once you have identified a nursing home that seems (on paper, at least) to be affordable, to have the services necessary and to have a vacancy, visit the facility. Ask to see the entire facility, not just the nicely decorated lobby or a designated unit. Try to get a feel for the quality of care and how residents are treated by the staff. Resident appearance, use of restraints, residents’ rooms, quality of food and activities are all–important factors in evaluating a nursing home. However, nothing is more important than the quality and quantity of nursing home staff.
How do you feel when you visit the facility? How does it compare to others? How did the administrator and staff treat you? Remember that you’ll be depending on these people to take care of your loved one. If you don’t like visiting there, imagine what it would be like living there.
People sometimes over–estimate the importance of an attractive building. While a nursing home should be safe, clean and comfortable, it doesn’t do the potential resident any good to choose a “fancy” nursing home if the resident can’t afford it, if it can’t meet the resident’s needs or if it is too far away for family and friends to visit.
Do comparative shopping. Use CANHR’s Fact Sheet, Nursing Home Evaluation Checklist to help you evaluate facilities under consideration.
Arranging Care During Hospitalization
Many people are admitted to nursing homes from hospitals. If your family member or friend is hospitalized, contact the hospital’s discharge planning or social work office as soon as possible to request assistance in arranging nursing home care. Hospitals are required to help patients locate and obtain care and services they will need upon discharge. Some hospitals are more helpful and cooperative than others but all are equally responsible to give you professional, timely assistance.
Hospitals cannot discharge patients to nursing homes without their consent and cannot charge for extra days of care if they have not met their discharge planning responsibilities. See CANHR’s Fact Sheet, Challenging Hospital Discharge Decisions,for more information on hospital discharge rights.
It is a good idea to review CANHR’s Fact Sheet on Nursing Home Admission Agreements before admission to a facility. CANHR also publishes several other fact sheets on nursing homes, such as Residents’ Rights and Making Care Plans Work, that give important information about your rights and how to get the best possible care.
Page Last Modified: April 15, 2019