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America's Best Nursing Homes

A look behind the rankings.

Avery Comarow - U.S. News & World Report
01/12/2010 Health & Fitness

At this moment, 1.5 million people are living in a nursing home, and in a typical year more than 3.2 million Americans will spend at least some time in one. That's a lot of families who need to find good care--and the reason for U.S. News & World Report's America's Best Nursing Homes. The U.S. News rankings are based on an analysis by the federal government, which collects data on almost all nursing homes and rates them in its Nursing Home Compare program.More than 15,000 nursing homes are ranked; the homes that have been top performers for four straight quarters are listed in an Honor Roll.

The information collected by the federal Centers for Medicare and Medicaid Services goes to the heart of safe, attentive, decent care for residents of long-term-care facilities. It is grouped into three categories: performance in health inspections, number of nurses, and quality of care. The agency gives homes ratings of 1 to 5 stars in each category and from those ratings, an overall rating of 1 to 5 stars. America's Best Nursing Homes fine-tunes the results, presenting the homes within each overall 1-to-5 star rating in tiers, by the number of stars they receive in total (15 is the highest number possible) and making them easily searchable.

Health inspections ratings reflect the results of visits every 12 to 15 months by state survey teams, which go through a checklist of some 180 items. Some are obvious, like infection control and food preparation safety. Other entries include medication management, residents' rights and quality of life, and proper skin care. A home's rating depends on how many "deficiencies" are found, how serious they are, and how many residents were (or could have been) affected. Besides regular inspections, investigators look into complaints from residents, their families, and anybody else who contacts the state to call a home to task.

The government wants to know the number of nurses a home employs, because first-rate care is not possible if there are too few nurses to give it. So the agency calculates how much time, on average, nurses and nurse aides spend with each resident per day. It's based on the size of the nursing staff, the number of patients, and the expected number of total hours. In the latest ratings, a home had to provide at least 33 minutes per patient to receive 5 stars. The quality-of-care rating relies on the medical status of residents in 10 measures related to pain, bedsores, and other clinical indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair.

Not many homes get a perfect 5 stars in all three categories, and very few manage to do it for four quarters in a row.  Here is the list of the 11 that take high honors in 2010. A few are pediatric facilities that are considered nursing homes because they provide Medicaid-funded long-term care or skilled rehabilitation services.

The 2010 America's Best Nursing Homes Honor Roll

Unfortunately, only a few people can take advantage of Honor Roll homes. The Best Nursing Home rankings, which are updated every quarter, can help locate others that fit families' needs. Searching can be by state, region, city, or ZIP code. If that turns up too many home to be manageable, search terms can be combined to find, say, homes within a certain distance of a particular city that have a religious affiliation.

Families can't rely just on rankings and data, of course. Here are practical tips that can help in a search:

Consider distance. A nursing home close by makes it easier to keep tabs on the care a loved one is getting. It also will make visits by friends easier.

See if residents' wishes count. If a married couple—or any other combination of opposite-sex roommates— wants to share a room, a progressive nursing home will allow it. If someone with diabetes wants to eat sweets regularly, the risks should be discussed, but the ultimate choice should be hers.

Find out how well the staff knows residents. A home that keeps the same nurses and nursing assistants with the same residents (called "consistent assignment") makes a big difference. Nurses and aides who see your dad day after day will catch medical issues more quickly. They will also see him more as an individual.

Check for lots of satisfying activities. Some residents may love singalongs, say. Those who find them annoying should have plenty of alternatives: Wii fitness sessions, meal preparation, swimming, on-site classes from a local college.

Ask about turnover. Caring for frail elderly folks doesn't pay well and can be physically exhausting. Discontent equals high turnover, which worsens care. Good homes involve staff in care decisions and give them perks they appreciate, like free or cheap meals and free flu shots.

Finally, look for homes that are in a movement to "de-institutionalize" nursing homes. They are stripping away sterile, hospital-like qualities like rooms lined up along corridors in favor of smaller "households" with 10 to 30 resident rooms around a communal kitchen and living room. Nurses deliver medications individually. Meals fit the resident, not the other way around. Overhead call bells are replaced by pagers or cells. The Pioneer Network is a leader in promoting the trend. A home that participates in the network is worth seeking out.

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Courtesy of U.S. News & World Report


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