When it comes to nursing homes, plan ahead

  • Article by: JANE E. BRODY , New York Times
  • Updated: September 1, 2014 - 7:28 AM

As crass as it sounds, looking for a good nursing home should be like shopping for a car. Test drive as many as possible.


For aging individuals who need 24-hour care, a nursing home may be the best option, but finding a place that suits the needs of the relative or friend - and those who plan to visit - requires considerable preparation.

Photo: Ellen Weinstein • New York Times,

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Nobody looks forward to spending the last years of life in a nursing home, yet 1.4 million Americans are living in this often-feared institutional setting.

You may not want to place a loved one in a nursing home for more than a short-term recovery, but never promise an aging relative that it won’t happen.

“The biggest mistake people make is waiting until the last minute, when faced with a crisis, to find a suitable facility,” said Joanna Leefer, author of “Almost Like Home,” a guide to choosing a nursing home. “You’re forced into an impulsive decision that you’re not likely to be happy with unless you’re really very lucky.”

Nursing homes generally have had a bad reputation as smelly, indifferent places where people go to die. But “there are some homes that are better than being at home,” Leefer said. “And there are many more good facilities than bad ones.”

Leefer developed her expertise through personal and professional experience, and her book is replete with checklists and scores of relevant websites. She learned a lot firsthand as primary caregiver for her aging parents, one of whom lived three years with nursing-home-type care. She worked five years for an advocacy organization for older adults, and she founded a consulting firm, ElderCareGiving, to help families make difficult care decisions.

(While the term “nursing home” has a specific meaning within the industry and for Medicaid, it typically is used by the public as a generic reference for several forms of senior housing that offer varying levels of care options, not all of which technically qualify as nursing homes.)

Finding a place that suits the needs of an aging relative or friend, and those who plan to visit, requires considerable preparation.

She likened it to shopping for a car: “Do the research, start looking around, find out what’s available, what each facility offers, what’s best for your loved one,” she said. “Become an educated consumer.”

Crass as it may seem, you might start with the cost. When paid for privately, the average ranges from $10,000 to $15,000 a month. Medicare does not pay for long-term nursing home care, only temporary skilled care, usually in the rehabilitation section of the home.

If the patient qualifies for Medicaid, and the nursing home accepts it, most of the cost is generally covered. The beneficiary must be 65 or older, disabled and a U.S. citizen. He or she can have no more than a certain amount in assets, as determined by the state. Some patients become eligible by transferring savings and assets to a third party at least five years ahead of time.

Next, choose a reasonably convenient location for likely frequent visitors. You can search for possibilities online by township or ZIP code. Ask neighbors and friends in the area for recommendations or information they might have about homes in the area.

How many stars?

Make a list of homes in the chosen area, and check out the government’s report card at Medicare.gov’s Nursing Home Compare site. Every home that receives federal funding must be evaluated and rated on a scale of 1 to 5 (5 being best). The assessments are far from perfect; a recent study, for instance, found that star ratings often don’t correspond to how patients feel about their nursing homes.

Still, Leefer suggests considering only homes with a rating of 3 or higher. Then start examining their characteristics.

What specialized services might the patient need? A dementia program? Mobility practice? Hospice care? Are there medical specialists on call? Is the home affiliated with a good nearby hospital? If the patient has a personal physician, you might prefer a home where that doctor has privileges.

If the patient is not fluent in English, are there staff members (and other residents) who speak the person’s language? Are there activities that would interest the patient, including opportunities to go outdoors?

Don’t rely on brochures. Take a tour, preferably more than once at different times, including mealtimes. Visit more than one floor. Does the place look and smell clean? An odor of urine is a clue to neglect. Are the rooms light and airy? Are residents permitted to have a few personal decorative items or furnishings?

Observe how patients are treated by staff members. Are they courteous, patient, friendly and respectful of patients’ privacy? Are patients greeted by the staff and addressed by name? Are those who need it helped with eating and drinking?

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