Senior Lifestyles

Need help finding a good nursing home?

One recent Sunday morning, I woke up to a text message from a co-worker saying that she’d been up all night with her mother in the emergency room.

Her mom had fallen, broken her hip and was getting admitted to the hospital for surgery. As you can imagine, my colleague was exhausted, worried and facing some important decisions. Even as her mom was being prepped for surgery, the hospital’s care coordinator was asking which rehabilitation facility she should be sent to afterward.

As a fellow official of the U.S. Centers for Medicare & Medicaid Services (CMS), my associate has a better-than-average understanding of the health-care system. But she’d never had to find a rehabilitation facility for a loved one. So she turned to an online tool CMS developed to help people find a suitable nursing home when they need one.

The tool – Nursing Home Compare – is available at Simply click the “Find nursing homes” button, enter your ZIP code or city and begin your search.

Nursing Home Compare assigns from one to five stars to every nursing facility that participates in Medicare or Medicaid, with five stars the highest rating. The star ratings represent three important dimensions of nursing home quality: health inspection results, staffing information and quality-of-care.

The goal of the rating system is to help people distinguish between higher- and lower-performing nursing homes. CMS also wants to help nursing homes identify problem areas and to improve their quality.

Performance indicators

Nursing facilities receive an overall star rating based on three types of performance indicators, each of which has its own star rating:

• Health inspections. Nursing homes that participate in Medicare or Medicaid undergo unannounced, comprehensive inspections about once a year. CMS bases health inspection ratings on the number, scope and severity of deficiencies found during the three most recent inspections, as well as on results of complaint investigations during the most recent 36 months.

• Staffing levels. CMS bases staffing ratings on two components: registered nurse hours per resident day and total staffing hours (registered nurse plus licensed practical nurse plus nurse aide hours) per resident day. The staffing measures are adjusted for different levels of resident care needs.

• Quality measures. These ratings are based on how a nursing home performs on 16 of the 24 quality-of-care measures currently posted on Nursing Home Compare. The measures reflect whether residents got flu shots, are in pain or are losing weight. They also look at how well the facility controls pressure ulcers (bedsores), whether it overuses antipsychotic medications and other indicators of how residents are treated.

A facility’s overall star rating is a composite of the ratings on the measures above. The core of the overall rating is the health inspection rating, which is adjusted positively if the facility receives high staffing or quality-of-care ratings, or negatively if those ratings are low.

You can compare multiple facilities on Nursing Home Compare, as my colleague did when looking for the best spot for her mother. But keep in mind that star ratings are intended to be combined with other sources of information (such as a doctor’s recommendation) and shouldn’t substitute for visiting the nursing home in person. Indeed, after my co-worker identified two possible facilities, she visited the one with an available room and was pleased to learn it had high ratings for food service, something very important to her mother.

At, you’ll also find “compare” websites for hospitals, home health services, dialysis facilities, medical equipment suppliers and Medicare-approved health and prescription drug plans.

Choosing a nursing home for yourself or a loved one is a complex, personal and often emotionally draining decision. With that in mind, we developed a detailed brochure, “Your Guide to Choosing a Nursing Home or Other Long-Term Care,” which you can find online at

Among other things, the brochure provides a checklist of questions to ask nursing home managers, offers alternatives to nursing home care and outlines the legal rights and protections of nursing home residents.

Greg Dill is Medicare’s regional administrator for California, Nevada, Arizona, Hawaii and the Pacific Territories. For more information, call (800) 633-4227.

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