Is that nursing home any good?

A hospital social worker hands you a list and says you have until Friday. Most families choose a nursing home in a hurry, and often in a crisis. The official record on every certified home is public, but it’s hard to read. This tool puts it in plain English.

It’s a place to start, and it can’t choose for you.

What the stars mean

Medicare gives each home an overall rating of one to five stars, based on three parts:

• Health inspections. State inspectors look at each home, and this rating counts how many problems they found and how serious they were. It covers the two most recent standard inspections and the last 36 months of complaint investigations.
• Staffing. How many nursing hours residents get, from payroll records, and how often staff leave.
• Quality measures. 15 measures of residents’ care, such as how many short-stay residents are re-hospitalized.

The overall rating starts with the inspection stars. It goes up a star if staffing or quality earns five stars, and down a star if either earns one.

Inspection stars are a comparison within each state. The top 10% of homes get five stars, and the bottom 20% get one. So four stars in one state doesn’t mean the same as four stars in another. If your parent could live in either of two states, compare what inspectors found, not the stars.

What the stars can’t tell you

Medicare says the ratings are meant to be used with other information, and that they can’t substitute for visiting the home. Keep in mind:

• A record looks backward. A home may have improved or slipped since the last inspection. If it hasn’t had one in over two years, the tool says so.
• Staff matter most, and stars can’t show you who’s on duty. Your parent will know the aides by name, not the rating.
• It’s a general picture. It can’t tell you whether a home knows how to care for someone with your parent’s condition.

How to read the staffing numbers

The tool shows hours of care per resident per day, next to the state and national averages.

• All nursing staff counts registered nurses, licensed practical nurses and nurse aides.
• Registered nurses have the most training, so their hours are shown separately.
• Weekends are worth a look. If the number drops a lot, ask who’s on duty.
• Turnover is the share of nursing staff who left in a year. CMS says higher turnover is associated with poorer quality of care.

Homes with sicker residents need more staff, so a national average isn’t a target. Use it as a reason to ask. If Medicare couldn’t validate a home’s numbers, or a home reported many days without a registered nurse on site, the tool tells you.

How to read inspection problems

When inspectors find a home isn’t meeting a federal rule, it’s called a citation. Each has a level:

Level	What it means
Potential for minimal harm	A small problem, with little risk to residents
Potential for more than minimal harm	No one was hurt, but someone could have been. Most citations are at this level
Actual harm	A resident was harmed
Immediate jeopardy	A serious risk to residents’ health or safety

These are Medicare’s levels, and the tool lists the most serious first. Each citation also says whether it was isolated, a pattern or widespread, and the description is Medicare’s own wording.

• Almost every home has some citations. The national average is about 9 at the last inspection. Look at how serious they are, and at whether the same kind of problem keeps coming back.
• “Came from a complaint” means someone complained and inspectors confirmed a problem.
• “The home is disputing this” means the citation is under a dispute process, and it doesn’t count toward the rating until that’s finished.
• A correction date means the home has a date for fixing the problem. It doesn’t tell you whether the problem has stayed fixed.

Fines and payment denials

The tool shows fines and payment denials from the past three years. A payment denial means Medicare or Medicaid stopped paying for newly admitted residents for a time. Ask what each one was for, and whether it’s been fixed.

The warnings

• Special Focus Facility. Medicare focuses extra attention on homes with a record of poor inspection performance. Homes in the program don’t get star ratings. A candidate is a home being considered for it.
• Cited for abuse or neglect. Medicare adds this flag when a home has been cited for abuse at harm level, or more than once at potential-harm level. The home’s inspection rating is then held to two stars at most.
• New owner. Much of the record may come from before the sale, so ask what’s changed.
• High-performing. This is Medicare’s mark for homes with fewer citations, higher staffing and other strong indicators.

Then go and see it

The tool writes questions for each home from its own record. Take them along.

1. Print Medicare’s checklist and take a fresh copy to each home.
2. Visit more than once, and at a different time of day. Try a weekend or a mealtime, without calling ahead.
3. Talk to residents and their families. Ask if they’d choose it again.
4. Read the contract before signing. A nursing home can’t require you to pay your parent’s bill with your own money. Our guide to when it may be time to move has more.

If your parent is already in a home and something’s wrong, every state has a Long-Term Care Ombudsman program that works to solve problems for residents. The Eldercare Locator at 800-677-1116 can find yours. If you suspect abuse or neglect, contact Adult Protective Services, and call 911 if someone is in immediate danger.

About this data

Everything in the tool comes from Medicare’s public nursing home data, and we change only the wording and the capital letters. We leave out the third, oldest inspection cycle, which doesn’t count toward the rating, and citations that were waived. Medicare’s Care Compare is the official version, and each report links to it.

We don’t recommend or rank homes. The list runs A to Z, and no home pays to be here or can pay to change its record. If something looks wrong, check it against Care Compare and tell us at hello@loveallofus.com.

What to do this week

1. Look up each home on your list, and print the reports.
2. Cross off any you wouldn’t visit, but don’t choose from the screen.
3. Visit the rest, with the questions in hand.
4. Go back to the one you like, at a different time.
5. Ask the hospital social worker how much time you really have.