How Do I Find A Good Nursing Home?

Guest Post by Cleveland Nursing Home Abuse Attorney Michael Hill.

“I am a trial attorney who takes on hospitals and other medical corporations when they choose to put their own profits ahead of their patient’s safety. My practice is focused on medical negligence and wrongful death, primarily delayed diagnosis and treatment of heart attacks and strokes, as well as birth injuries. My residence is in Ohio, but I handle cases throughout the United States.”
Michael Hill

Finding a nursing home can be a confusing, disheartening, and challenging process. This is especially true when you have little time to choose a nursing home after a hospital announces that your loved one is being discharged.  While no method is perfect, there are more tools available than ever to find a suitable long-term home for your loved one.

In principle, nursing homes serve society by providing care for people who have chronic illnesses.  In reality, however, nursing homes often fall far short of this goal and in many cases place nursing home residents at risk of serious injury.

Nursing home residents are often injured because the nursing home industry places its profits over the safety of its residents.  This is especially so when nursing homes systematically understaff their facilities to increase their profit margins at the expense of resident care.

Nursing homes are required to provide reasonable, adequate, and appropriate medical care to their residents.  Ohio’s Nursing Home Bill of Rights[1] provides an illustrative list of rights each nursing home is required to provide to its residents.

Federal regulations require that nursing homes provide that level of care and those services necessary to attain or maintain each resident’s highest practicable physical, mental, and psycho-social well-being.[2]

The nursing home must individually assess the needs of nursing home residents and develop a comprehensive care plan that includes measurable objectives and timetables to meet each resident’s medical, nursing, mental and psychosocial needs that are identified in the assessment.[3] Once an appropriate plan has been developed, it must be implemented.

Elder abuse and negligence often occurs when a nursing home resident is improperly assessed, when the care plan is never developed or ignored, or when there is no intervention following a change in the resident’s status.

There are numerous federal and state laws and regulations that guarantee certain rights and care to nursing home residents. Residents and family members can enforce these rights through negligence and wrongful death lawsuits.

It is important to find a long-term care facility that is appropriate for your loved one before they are injured by neglect or abuse.

Initial Search for a Nursing Home

Before you do a lot of leg work searching for a nursing home, one of the easier things to do simply ask others about their own experiences.  Who to ask?

  • Ask an elder law or Medicaid asset protection lawyer like Dawn McFadden or Christina Bushnell for their experience helping families place a loved one in the right nursing home;
  • Ask an attorney who investigates nursing home negligence, neglect, or abuse, like Eadie Hill Trial Lawyers;
  • Ask your doctor, family, friends, clergy, and neighbors about their experiences with nursing homes;
  • Contact a social services agency and speak with a case manager about nursing home options;
  • Contact a local Agency on Aging for recommendations—directories are widely available on-line;
  • Ask a hospital’s social worker or discharge planner for recommendations; and

While not scientific, these anecdotal accounts may be the single most valuable part of an investigation.

Online Tools to Help Find a Nursing Home

ProPublica, the nonprofit investigative news organization, offers a tool called Nursing Home Inspect.   This tool allows users to compare nursing homes in a state based on the deficiencies cited by regulators and the penalties imposed in the past three years. You can also search over 60,000 nursing home inspection reports to look for trends or patterns.

The website is updated monthly as the Centers for Medicare and Medicaid Services (the government agency that surveys the nation’s 15,000 nursing homes) posts additional information.   These reports are limited, however, to the few times that regulators actually inspect a nursing home. Therefore, these reports will not give you an actual day-to-day review any particular facility.

Although less user friendly than Nursing Home Inspect, since July 2012, the Centers for Medicare and Medicaid Services has put online the full text of the reports that nursing home inspectors file for each facility.  You can obtain the full findings by selecting “Inspections and Complaints,” then click on “View Full Report.”

Prior to 2012, these reports were only available through requests made under the Freedom of Information Act.

Centers for Medicare and Medicaid Services’ Nursing Home Compare ranks nursing homes using a star-rating system, with a one star rating being the lowest and a five star rating being the highest.

Nursing Home Compare

The government promotes this tool for consumer shopping comparison.  What many people do not know is that these star ratings only reflect staffing levels during a two-week window that are self-reported by the nursing home.  While a one-star rating is a truly bad sign, a five-star rating may not be much better on a day-to-day basis.

Nursing homes have developed ways to artificially inflate their numbers and improve their star rating.  We previously reported how nursing homes can inflate the staffing numbers that are reported to Medicare to increase their ratings.

There is evidence that 80% of nursing homes inflate their staffing numbers in order to get higher rankings from Medicare, according to the Center for Public Integrity.

Even the Centers for Medicare and Medicaid Services (the federal agency responsible for overseeing nursing homes) has talked repeatedly since 2001 about the inaccuracy of self-reported data. This means that family members who search Medicare’s Nursing Home Compare are commonly mislead about the amount of staff that are actually available at the facility.

The single greatest discrepancy in the reported amount of staff and the actual amount of staff relates to the number of registered nurses at the nursing home.  Registered nurses cost far more for nursing homes to employ because of their training and expertise.   Study after study has shown that there is a direct connection between the amount of care—especially registered nurse care—and resident well-being.

These discrepancies in reported-versus-actual staffing levels may explain contradictory reports from family members concerning their satisfaction with nursing homes.   While you would expect fewer stars to equal less satisfaction, a recent report out of Ohio says differently.  On the one extreme, 20 percent of individuals and their family members provided high marks to the lowest performing nursing homes, those ranked with a single star.  On the other extreme, forty percent of individuals and families gave very low marks to the highest performing nursing homes, those with rated as five stars.

The study concluded that there was little difference in satisfaction between stars, i.e., between one and two stars and between two and three stars.

While no tool is perfect, there are more on-line tools available than ever to locate an appropriate nursing home.  These tools can assist with other steps to search for a reputable home for your loved one.

Visit the Nursing Home

After you’ve done your initial research, start visiting nursing homes.  Do not choose a nursing home because it looks nice—with atriums and waterfalls—or because it has good marketing pamphlets.  Like any business, the amount of money devoted to marketing does not necessarily translate to better patient care.  (In fact, it can be just the opposite.)

I have represented numerous families who fell into the trap of selecting a nursing based on appearance and a great sales pitch, only to later learn after their parents were injured and in some cases died. In those cases, the staffing levels and care were far less than advertised.  There are countless stories and lawsuits, including many that I have seen firsthand, of pressure sores and falls as a result of mistreatment at nursing homes.

The Centers for Medicare and Medicaid Services has published a 7-page Nursing Home Checklist that it recommends people take when touring a nursing home to determine whether it is a fit for you and your family member.

The items on the checklist are helpful.  In addition to those items on the checklist, you will also want to ask or consider the following questions as you tour the facility:

  • Are there a lot of visible staff members?
  • Are call lights going unanswered?
  • Do the staff members appear hurried, annoyed, or overworked?
  • Is the staff respectful and friendly?
  • Is the nursing home clean?
  • Does the nursing home offer interesting social, recreational, religious, and cultural activities?
  • Can you choose your waking, bed, and bathing times?
  • Ask to try the food. Is the food good? Can you get it any time?
  • Ask to see the cafeteria? Is it busy? How do the residents look?
  • Can you have visitors anytime?
  • Can you have a pet?
  • Is transportation provided?
  • Can you decorate your room in any way that you like?
  • If you see someone visiting a loved one, ask about their experiences.

Search the Court Docket for Lawsuits against the Nursing Home

In most jurisdictions the court docket is now online.  You can usually find lawsuits that have been filed against a nursing home by searching the “civil docket” by the name of the nursing home.  Keep in mind that in many instances the name on the front of the building is not the actual name of the nursing home.  It may take some research to determine the actual name of the corporate entity that owns the nursing home.

At a minimum, you will be able to compare the number of lawsuits, including the types of lawsuits—e.g., negligence, wrongful death, etc.—that have been filed against one facility as opposed to another.  It is becoming increasingly common for courts to post documents, including complaints and other materials that have been filed which will allow you to actually see the allegations being made.

Conclusion: Take Your Time

Finding a nursing home is a stressful process, but with some guidance and proper tools, you can hopefully find one that is a good fit for you and your loved one.  The fact that you’re on the website of a trusted elder law firm like McFadden Bushnell means you’re on the right track and thinking about the right things.  Keep reading their information, or give them a call.



[1] R.C. 3721.13

[2] 42 C.F.R. § 483.25.

[3] 42 C.F.R. § 483.20(b)(1)-(2); 42 C.F.R. § 483.20(d); 483.20 (K)(1).