Nursing Homes Rated
WSJournal June 1, 2009 Health Costs
The federal government is stepping up efforts to improve the quality of nursing-home care and now has an online tool consumers can use in evaluating facilities.
The Centers for Medicare and Medicaid Services, or CMS, will start running a pilot program this summer to see if cash incentives to nursing homes can improve the care they provide, especially in areas such as nurse staffing and preventable hospitalizations.
Separately, in December, the agency started ranking facilities based on government inspection results, staffing data and quality measures. This "Nursing Home Compare" system, which gives one to five stars to 16,000 nursing homes, is available at http://www.medicare.gov/NHCompare/.
The agency also flags some of the most troubled nursing homes -- now about 135 -- on the Web site.
"We are certainly taking assertive steps to make sure nursing-home residents are adequately protected and to stimulate improvement on the part of various providers," says Thomas Hamilton, director of CMS's survey and certification group.
About three million Americans need nursing-home care at some point each year, and the care is often costly. Unlike with most other health-care needs, many elderly and disabled Americans have to pay for nursing homes themselves, either because they earn too much to qualify for Medicaid or they don't qualify for Medicare's coverage.
Limited Medicare Coverage
Many seniors are surprised by Medicare's limited coverage for nursing-home care: up to 100 days after a hospitalization of three days or more.
To qualify, a patient must have a doctor's order to go to a nursing home for the same illness or injury that he or she was treated for at the hospital, for services such as physical therapy or IV injections, according to AARP, an advocacy group for older Americans.
The beneficiary pays nothing during the first 20 days at a nursing home, $133.50 a day after that and the full cost after 100 days.
Advocates say consumers should do their homework before choosing a nursing home, because care can vary widely. They suggest that patients -- or their family and friends -- visit a nursing home in person, talk to residents there and look at data on the facility.
New Online Information
The U.S. "Nursing Home Compare" Web site is a good place to start. It lists nursing homes with summarized data from state and federal inspections and information the nursing homes reported to regulators.
There are some caveats. The National Citizens' Coalition for Nursing Home Reform, an advocacy group, warns that some data provided by nursing homes to the Nursing Home Compare Web site may contain errors.
Consumers, the group says, should also check with states and other sources to get a better picture of facilities.
CMS says consumers should check for updates -- which can appear every month -- because nursing homes often have high turnover rates, which affect patient care.
The government labels the most troubled facilities as "Special Focus Facilities" -- a designation that shows up when you look up one of those facilities in Nursing Home Compare.