Nursing Homes


While most of us desire to keep our loved ones and friends in their residence as they age, many individuals will eventually end up in a nursing home due to multiple chronic ailments and the inability to engage in essential daily tasks and the lack of skilled care that may be available for at-home care.

And others will eventually end up in a nursing home because they cannot afford to remain in their home, do not have family members or friends who can care for them, or need to use the services of Medicaid to live in an environment that can meet their needs and provide a safe, secure environment.

Of those citizens age 65 or older, about 5% are in a nursing home at a given time. For those who are 95 years of age or older about 50% reside in a nursing home. While the insurance industry often notes that the average stay in a nursing home is approximately 2.5 years, about 68% of individuals who enter a nursing home are discharged within 90 days.

According to the Center for Disease Control and Prevention, there are over 16,100 nursing homes in the United States with a total of approximately 1.7 million beds. The cost of most residents’ stay is paid from a combination of private pay and Medicaid or Medicare.

How Do People Select a Nursing Home?

A study conducted by the Rand Corporation in 2006 found the following:

  • most people do not use the wide variety of information available to them when selecting a nursing home
  • many people reported that information was not available at the time they needed to make a decision in selecting a nursing home
  • denial or lack of understanding of a loved one’s condition often placed people in a position where they had little time to make a decision in their selection
  • consumers were more sensitive to perceived quality issues than technical information which influences the quality of care
  • many individuals are not familiar with government Internet sites that provide information on the quality of facilities nor were they aware of nursing home inspection reports

Selecting a Nursing Home and Resident’s Rights

ElderLawAnswers provides a useful list for choosing and evaluating a nursing home, dealing with legal issues that may arise with nursing home care and residents rights. The information on this site will be very useful for families beginning the process of seeking a nursing home.

The New Hampshire Health Care Association provides detailed list of criteria for selecting a nursing home or assisted living facility. Topics included in their list include licensure, qualifications of staff, planning of services, activities and services provided to residents, staffing, location, costs and fees, and toilet facilities.

The U.S. Department of Health and Human Services provides a through checklist for evaluating a nursing home. This checklist covers basic information on the facility, information on licensure, training, background checks of employees, staff training and loss prevention. Another section of the checklist covers questions covering quality of life and quality of care, safety, and nutrition and hydration. This is well written checklist that allows for a thoughtful and objective evaluation and comparison of nursing homes.

The Centers for Medicare and Medicaid Services has published a booklet that is avalable on-line entitled Guide to Choosing a Nursing Home.  This 67 page booklet addresses the following topics:

  • Agencies that can help with long-term care choices
  • Alternative long-term care choices
  • Finding our about nursing homes in your area
  • Compare the quality of nursing homes you are considering
  • Visiting the nursing homes you are interested in
  • The nursing home checklist
  • Choosing the nursing home that meets your needs
  • Making the arrangements to enter a nursing home
  • Paying for nursing home care and other health care costs
  • Nursing home care plans
  • Reporting and resolving problems
  • Your resident rights and protections
  • Listings of free booklets on Medicare, information on specific diseases and conditions, and important telephone numbers

Strategies for Working with Discharge Planners is a Web page provided by the Family Care Alliance. This is an important source of information for individuals who may be placed in the position of addressing the on-going needs of a loved one who is unexpectedly discharged from the hospital.  This page provides guidance and four sets of questions that should be presented to the discharge planner: questions about the illness, questions about treatment and care, questions about where you can find help in the community, and questions that you, as caregiver, should ask about your ability to perform needed tasks.

Nursing Home Compare is a comprehensive search able index of nursing homes provided by the U.S. Department of Health and Human Services. Users can search for nursing homes by zip code, state, county, the name of the nursing home , or by city. Once you have entered the location you which to search you are provided a list of nursing homes and the following information for each facility:

  • The facilities overall rating.
  • The facilities’ health inspection rating.
  • The nursing staff’s rating.
  • A rating of quality measures.
  • If the facility accepts Medicare and/or Medicaid residents.
  • The number of certified beds.
  • The type of ownership (profit, non-profit

The U.S. Department of Health and Human Services has developed  a Web site for the National Clearing House for Long-Term Care Informationwhich provides a variety of information and useful link to services on long-term care. Included on tis site are the following:

  • A long term care planning kit that discusses financing long-term care, understanding long-term care insurance with an extensive checklist to compare insurance plans, finding out what your community has to offer, and legal considerations,
  • A section on understanding long-term care that includes a discussion of risks and a definition of various types of care, a description of the types of care and providers.
  • A section on planning for long-term care that includes a discussion of the importance of long-term planning, planning information and resources, and planning steps.
  • A section on paying for long-term care that includes a description of the actual costs of long-term care, a “clickable” map that provides the costs in major cities and a statewide average cost for long-term care, and a description of who pays for the different types of long-term care.

Nursing Home Rights

Nursing home residents have patient rights and certain protections under the law. The nursing home must list and give all new residents a copy of these rights.

Resident rights usually include:

  • Respect: You have the right to be treated with dignity and respect.
  • Services and Fees: You must be informed in writing about services and fees before you enter the nursing home.
  • Money: You have the right to manage your own money or to choose someone else you trust to do this for you.
  • Privacy: You have the right to privacy, and to keep and use your personal belongings and property as long as it doesn’t interfere with the rights, health, or safety of others.
  • Medical Care: You have the right to be informed about your medical condition, medications, and to see you own doctor. You also have the right to refuse medications and treatments.

Nursing Home Inspection Reports

The AARP provides a State by State Guide to Nursing Home Performance Data provides information as to whether a given state provides on-line nursing home reports, where informatino on nursing homes can be obtained, and contact information of state agencies or ombudsman programs for nursing home care.