Using Medicare's Nursing Home Compare to Find Quality Elder Care

Visually inspecting a prospective nursing home isn't enough to make sure the facility meets your standards as well those put in place on the state and federal level. Nowadays, you need to do your footwork -- and homework -- before choosing an elder care residence for your loved one. 

While the Internet is a good place to start researching area nursing homes, you need to make sure the information you obtain is accurate and reliable. A reputable site to check is Medicare's Nursing Home Compare. This online tool rates and reviews nursing homes throughout the United States, allowing consumers to scope out facilities before they go in for a visit.

Understanding How Nursing Home Compare Works 

In 1998, the U.S. Department of Health and Human Services (HHS), along with the Centers for Medicare & Medicaid Services (CMS), implemented the Nursing Home Compare website for consumers who want to know about the parameters of a specific nursing home's care. The site provides data, as well as a quality rating, on the past performances of all Medicare- and Medicaid-certified nursing homes. However, the site only compares data from nursing homes that provide skilled nursing care (rehab, physical therapy, etc.).

The information on this site is from various factors including nursing home inspections and staffing. The consumer inputs the community or city of their choice and analyzes the data returned on all the certified nursing homes in that area. In theory, it forces poorer-performing facilities to improve their quality so they can compete with higher-rated homes. Consumers are able to view the results of a nursing home's three most recent inspections or surveys.

What Makes Up a Nursing Home Compare Inspection? 

On average, the state of California inspects its Medicare- and Medicaid-certified nursing homes once a year; more often for lower-performing facilities. During the inspection, an examiner from the state health department or department of human services looks at all aspects of care and determines if the nursing home meets the minimum performance standards set forth by the government. These regulations must be met in order for the nursing home to receive Medicare or Medicaid services.

Five-Star Quality Rating 

Following the evaluation, each nursing home will receive a quality rating, ranging from one to five stars, based on the data received about the heath inspections, staffing and quality measures. Nursing homes that receive one star means the standard of care in that category is much below average, while five stars corresponds to much above average care. On the website, consumers can choose up to three nursing homes at a time and compare their quality ratings, as well as the results of the fire inspections, penalties against the nursing home (if any) and number and types of complaints and incidents. A typical survey includes:

During the process, the inspection team observes the environment as a whole, as well as residential care and staff/resident interaction. They also interview residents and their families about life at the nursing home, reviews clinical records and speaks with caregivers and administrators. 

• Health inspection: The examiners, along with at least one registered nurse, evaluates the care of the residents and the processes used to give that care, how the staff and residents relate to each other and the nursing home environment in general. They specifically look at the residents' medication management, storage and preparation of food, and whether the elderly are subject to abuse or inadequate care. Examiners take note of any violations.
• Fire safety inspection: Specialists in this field analyze whether the nursing home meets the standards ordered by the National Fire Protection Agency. They make sure the facility is properly designed to protect the residents in case of a fire, smoke or other emergency. Inspectors check many areas to make sure they are in working order including: Exit doors, signs, smoke alarms, fire doors, sprinkler systems and fire extinguishers. A properly executed emergency plan must also be in place. The evaluation will note any violations.
• Staff evaluation: Nursing homes must have enough staff to adequately care for residents and regularly report to their state surveyor agency; therefore, the survey inspects the number of staff hours per resident per day. In Nursing Home Compare, consumers will see a home's staffing levels for the two weeks prior to the state inspection. However, as of 2012, there wasn't a system in place to verify that the information received by the state from the nursing home is accurate. Consumers can review each nursing home's staff hours per resident per day on the Nursing Home Compare site.
• Quality data and measures evaluation: Nursing home administrators report assessment information to Medicare about the overall well-being of their residents such as health, physical functioning and mental statuses. Medicare then looks to make sure quality measures are met, such as flu shots for residents, number of falls or accidents, pain level of the residents and so on. Each nursing home is then given a score based on these quality measures.
• Analyzing the home's characteristics: There are many factors that make up this part of the survey such as nursing home ownership, participation in Medicare and Medicaid programs, number of certified beds available and occupied, types of care provided and number of complaints or incidents. 

An Important Note 

In 2012, CMS started revamping Nursing Home Compare to display new quality measures and provide more information for consumers looking for a solid nursing home. It is also important to note that also at this time, the Five Star Quality Rating was only based on information provided during 2010; it is not current. Medicare expects to have it updated by the end of the year.

As a potential client, do not base your overall experience with a nursing home solely on the information found on Medicare's website. You need to visit the facility and experience life there for yourself before you decide on whether it is the proper facility for your loved one.