How Do I Tell A Good Nursing Home From A Bad One?

In 2001, the Centers for Medicare and Medicaid Services (CMS) reported to Congress that 91% of nursing homes in the United States did not have sufficient staff to prevent harm to residents. The Centers for Medicare and Medicaid Services released the “National List: Nursing Homes Targeted for High-Risk Pressure Ulcers” (bedsores) and/or “Physical Restrain Improvement”, and 4,000 nursing homes were found deficient in these two important categories of care. The prevalence of pressure sores and the use of restraints are indicators of neglect and insufficient staff.

The small the underpaid and unskilled the staff is, the more money nursing homes can make. There are strong financial incentives for nursing homes to cut corners, not only in the number of staff, but also in the training and qualifications of the staff. Most of the revenue of nursing homes comes from Medicare and Medicaid, but the owners of nursing homes need not account to Medicare or Medicaid for how they spend the money they are paid. As a result, the number of lower paid and less trained nursing assistants has increased.

The number of ratio of aides/nurses to residents may be one aid for 15 residents during the night and it is not unusual to find a lone nurse or aid caring for as many as 30 residents. The low staffing will result in poor quality of care, such as malnutrition of residents, bedsores, urinary tract infections, residents confined to their chairs or bed, and neglect.

The New York State Department of Health measures performance rankings of all nursing homes in New York at the Department of Health’s Nursing Home Profile at For each quality measure, the nursing homes in New York are divided into five groups according to their scores, with roughly 20% of the nursing homes in each group.

The quality measure performance rankings show how the nursing homes rank in relation to other nursing home sin New York. There are performance rankings for the percentage of residents with urinary tract infection, the percentage of residents who were physicially restrained, the percentage of residents who have pressure sores, the percentage of residents who lose too much weight, and the percentage of residents who have had a catheter inserted and left in their bladder.

The performance ranking for the percentage of residents with urinary tract infections is a good indicator of the sanitary practices of the nursing home. Most urinary tract infections can be prevented by keeping the area clean, emptying the bladder regularly, and drinking enough fluids. The nursing home staff should make sure that the resident has good hygiene.

The performance rankings on the NYS Department of Health’s website do not indicate any relationship to national ranking, except on the page giving New York State average scores, there is a performance ranking against the respective national averages.

Medicare also provides a performance ranking measure of nursing homes at its webpage, At this useful website, Medicare lists specific information for nursing homes throughout the United States concerning home staffing, quality measures, and health inspections, and you can compare three nursing homes in each category.