What to Know

Most nursing homes are understaffed to the point of endangering patient care. More than a million vulnerable people need quality long-term care.  There are about 15,000 nursing facilities today, down from 19,000 in the 1980s. Kiplinger released an article with the 10 things consumers should know about nursing homes.  Here is a summary.

1. Nursing homes have changed

Nursing homes provide round-the-clock nursing care required by chronically ill or disabled people who are the most in need of assistance.  According to one study, for example, nursing home residents who required help bathing increased from a facility average of 89% in 1985 to an average of 96% in 2015; those requiring help dressing rose from 74% to 92%. The study also found that the proportion of residents with dementia increased from an average of 39% in 1995 to 45% in 2015.

Nursing homes are required by law to treat residents with respect and to allow them to participate in activities. The law also bars the use of restraints and requires the safekeeping of residents’ personal property.

2. They offer both long- and short-term care

The average stay is one year. Many residents live in nursing homes for short-term, rehabilitative stays. These are often covered by Medicare, which pays for up to 100 days of care per benefit period. Longer stays are not covered by Medicare or private health insurance, although they may be covered by long-term-care insurance or Medicaid.

3. Nursing home care is expensive

The American Council on Aging states the average cost for a private room is $108,405 a year. $94,900 for a shared room.  About half of the total nursing home costs in the country are paid by Medicaid.

4. You can use data to find a good nursing home

CMS collects data on resident health, including things like weight changes and bed sores. This data and nursing home star ratings (5 stars being the best) are available at the Care Compare website of the Centers for Medicare and Medicaid Services. One important data point is staffing.

You want to be over 4.1 hours [of nursing care] per day” for each resident, says Sam Brooks, director of public policy at The National Consumer Voice for Quality Long-Term Care, a public advocacy organization. “The higher, the better.”

Lower levels of staff turnover are also important, as they indicate consistent care and work satisfaction.

5. They are short on staffing

Most nursing homes do not provide sufficient staffing to ensure basic quality. More than half of U.S. nursing homes have lower nurse staffing levels than those recommended by experts and one quarter of nursing homes have dangerously low staffing, according to researchers. One reason is low pay.

6. Pay attention to the form of ownership

About 70% of nursing homes in the U.S. are operated for profit, about 25% are nonprofit and the rest are owned by government entities. Generally nonprofit nursing homes have higher staffing levels.

On average, nonprofits provide 4.28 hours of staff attention per resident each day, while for-profits provide 3.56 hours.

7. COVID-19 and other infections ravage nursing home residents

According to a government report, nearly 166,000 nursing home residents and more than 3,000 staff members died from COVID-19. And the Department of Health and Human Services estimates that up to 380,000 nursing home residents died from infections such as pneumonia each year before the pandemic.

8. Nursing home residents need outside help

“Families are essential,” says Lindsay Peterson, assistant professor at the School of Aging Studies at the University of South Florida. “Nursing homes are supposed to be the resident’s home, and if that means a family caregiver wants to be with them, the facility cannot prevent them from being there.”

If family isn’t available, Peterson suggests a geriatric care manager or life care manager. Information is available at the website of the National Institute on Aging.

9. Nursing homes may be more profitable than they appear

About half of U.S. nursing homes claim they are not profitable. But — and it’s a big but — nursing home companies may have ways of getting over the red-ink flow.

Billions of dollars of nursing home funding wind up at third-party companies that are owned by companies that own the nursing homes — like landlords collecting rents or pharmacies supplying patients’ drugs, according to a National Consumer Voice report.

“Nursing home owners and operators routinely pay their related parties in excess of reported costs, in some instances by nearly 1,200%,” the report says. 

10. Reforms are in the works

The Biden administration last year launched an effort to improve nursing home care, aiming to increase transparency in ownership, create minimum staffing requirements and increase private rooms for residents. The issue even made it into the president’s state of the union address this year when he said, “We’re protecting seniors’ lives and life savings by cracking down on nursing homes that commit fraud, endanger patient safety, or prescribe drugs they don’t need.”

The White House has already launched an effort to beef up staffing, an initiative welcomed by consumer advocates but resisted by some industry groups.