Medicare's Rules for Eligibility for Home Healthcare Services
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What is Changing about Long Term Care?

Long-Term Care: Comparing Nursing Homes

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Nursing home care comes in two types: here the emphasis is on long-stay choices. Follow some simple steps for selecting a nursing home for your long-term care needs. If you or your relative is in a continuing-care retirement community with a nursing home unit, you have already made an initial choice.

Nursing Home Compare is an online tool that includes information on health inspections and complaints, staffing (hours of care provided by nurses and nursing assisstants per resident), and quality measures such as incidence of pressure sores. CMS maintains the database that compares more than 15,000 Medicare- and Medicaid-certified nursing homes that provide skilled services.

The online tool ranks nursing homes based on three ratings, two of which are self-reports by the nursing homes. Only state inspections are external evaluations. These three ratings (from a low of 1 to a high of 5 stars) are combined to calculate an overall rating. In addition, Nursing Home Compare reports penalties that have been imposed on the facility.

Nursing Home Compare is a valuable tool that allows you to eliminate some of the lowest-ranking nursing homes. However, it does not include many important factors such as the interactions between management and staff, and between staff and residents, how residents’ individual needs and preferences are addressed, and the general atmosphere and style of the facility.

These are factors you need to assess in your visits. Given two nursing homes with similar ratings, you need to take the next step of determining which one seems to best meet your needs or those of your parent.

One thing to keep in mind is that Nursing Home Compare includes data from a limited period. More important, even the data coming from inspections in some states may tend to underreport deficiencies. And Medicare uses a grading curve, so exactly 10 percent of nursing homes in any one state are awarded the top ranking of five stars.

This means that a lower-ranking nursing home might have just missed the cutoff on the ranking curve; on the other hand, it might mean that the curve limits the number of nursing homes that would fall into the lower categories.

In addition to Nursing Home Compare, many state departments of health have similar comparisons on their websites. Other sponsored websites offer to compare nursing homes, but they generally base their data on government websites and may include only facilities that pay to be on the list.

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