Choosing a Nursing Center for Long or Short Term Care

What is Most Important?

The single most important advice about selecting any long term care service is to visit potential providers, ideally more than once. There are numerous check lists available from credible sources such as Medicare and the state Department of Health and Human Services that can provide good questions to ask. Links are provided below.

We believe the most important consideration in selecting a nursing or assisted living center should be about the people who will provide care; their attitude, compassion, competence and training will have the largest impact on the experience, well-being and health of the patient or long term resident. Do they demonstrate sincerity, compassion and warmth for the people they are caring for? Do the employees you meet in the facility tour seem engaged with residents and demonstrate the feeling that they genuinely relate with the residents. It can’t be just a job!!

The care environment and accommodations are important also, but after the relationships of the people. The center should look residential or like a nice hotel not a medical institution. Does it look like a home you would like to visit or live in? Are there places where residents and family members can sit and talk with privacy?

Part of the care environment is compliance with state and national Life Safety fire codes and information on such compliance can also be found on the Medicare web site. 

Ratings of Nursing Homes and Assisted Living Centers

Medicare Compare

Medicare provides a rating system that provides a Star Rating system for all Medicare or Medicaid certified nursing homes in the country. The rating system incorporates information from the 3 most recent state/Medicare inspections, quality data from quarterly submissions of patient assessment data made to the state as well as staffing levels reported to the state annually by the nursing homes.

There have been numerous critiques of the rating system for relying on some self-reported unaudited information from nursing homes as well as the fact that the annual unannounced state/Medicare survey process itself is flawed due to the subjectivity and variability of survey deficiencies cited by state inspectors. In addition there is some delay in reporting and updating information on the site so some information may be out of date.

While the criticisms of the site have some merit and the system is imperfect, it is a good starting point of information that can be useful to review with a nursing center that you may be interested in. It would be appropriate to ask the Administrator or Director of Nursing of a nursing home to review a copy of the Medicare ratings and inspection reports and to hear their explanations of any deficiencies.

In addition to the Medicare rating systems some states may provide their own rankings or ratings but New Hampshire does not have such a system.

Third Party Web Site Ratings and Referrals

Beyond the Medicare or any official state rating/ranking systems there are many other web sites that offer ratings of nursing homes and assisted livings. Be very cautious in relying on information from such web sites. To the best of our knowledge almost all other web sites listing information or rating nursing homes do so based on information they gather from the Medicare web site and they do not gather independent information. These third party ratings may attempt to interpret the Medicare data using mathematical screening measures but they also may not keep their data gathering from Medicare up to date.

The other cautionary issue is that a number of nursing home and assisted living rating sites rely on paid subscriptions from providers who are listed on the rating site as their “preferred” or recommended providers. These web sites are largely a referral mechanism which may be helpful in locating some providers but any ratings they offer may not be objective.