Millions of older Americans need help meeting their care needs. This may include assistance with fundamental tasks like bathing, dressing, using the toilet, incontinence, transferring to or from a bed or chair, and eating. These tasks are commonly referred to as “activities of daily living.”

Many people who need help with activities of daily living can continue to live at home. Unpaid care-giving by family and friends is the main source of this assistance.  Today, a large percentage of our nation’s long term care needs are met in the home by care provided by family members and friends.

But care requirements can rise to a level than cannot be appropriately met at home. Because of family circumstances or the level of care required or the cost of round the clock care, home care can place unacceptable burdens on the family and put the care recipient at risk. If the care recipient does not need a high level of medically oriented support there are a number of residential care alternatives that may become appropriate. For a discussion of these options see my previous blog post When Mom Can’t Live Safely at Home – Residential Care Facility Options for Seniors.

If care requirements are complex or extensive or require skilled medical support a traditional nursing home may the best residential care option. [When I use the term “nursing home” in this article I mean a facility that provides 24-hour health care services including basic and skilled nursing care, rehabilitation, and a full range of other programs, treatments and therapies such as occupational therapy and physical therapy.] Nursing homes may also manage complex medical needs that require equipment, such as ventilators and IV lines. Nursing homes are medical facilities that are inspected and licensed in Pennsylvania by the state Department of Health. They must comply with both state and federal regulations.

Nursing homes are sometimes referred to as “skilled nursing facilities” or “long term care facilities” or “nursing care facilities” but are most commonly simply called nursing homes. I will use that term.

Nursing homes may be stand-alone or they may be part of a hospital or of a Continuing Care Retirement Community. As of June 30, 2012, there were 713 nursing homes in Pennsylvania with a total bed capacity of over 88,000. Most, but not all, facilities accept Medicare and Medicaid for those who qualify for benefits under those programs. Other sources of payment include private payment, long term care insurance, and VA benefits. Since some nursing homes do not accept Medicaid – you should check in advance if there is a possibility that the resident may someday run out of private payment funds and need to rely on Medicaid.

Pennsylvania residents can check the Pennsylvania Department of Health’s Nursing Care Facility Locator Page to find nursing homes near them. And Medicare provides a list of Medicare participating nursing homes on its Nursing Home Compare website. The Medicare site is deep with information and gives each home a quality rating between 1 and 5 stars. There is one overall rating for each nursing home, and a separate rating for each of the following three sources of information:

• Health Inspections – based on information from the last 3 years of onsite inspections;
• Staffing – based on the number of hours of care provided on average to each resident each day by nursing staff; and
• Quality Measures – based on 11 different physical and clinical measures for nursing home residents.

Of course, as Medicare itself cautions, “no rating system can address all of the important consideration that go into a decision about which nursing home may be best for a particular person.  Examples include the extent to which specialty care is provided (such as specialized rehabilitation or dementia care) or how easy it will be for family members to visit the nursing home resident.” Family visits can improve both the residents’ quality of life and quality of care, so it may actually be better to select a nursing home that is very close over one that is higher rated but far away.

Consumers should therefore not rely solely on the Nursing Home Compare website. Consider other sources of information including that provided by state and local organizations (such as local advocacy groups and the State Ombudsman program).

The quality of the care provided by a nursing home is dependent on its staff. And there is often a lot of staff turnover. This means that the quality of the care in a particular facility can vary greatly over time. And some floors or units in a facility can have staff that provide better care than another unit in the same facility. The knowledge and opinions of current or recent residents of a facility and their family members can be an invaluable source of guidance.

If you are fortunate enough to know residents of the facility or members of their families don’t hesitate to talk with them. And, if you can, consult with a professional care manager who is independent of the facilities you are considering. Be sure to include personal visits to the nursing homes you are considering. But beware of referral companies that are paid by facilities to make referrals to them. You need independent recommendations from local people who have no financial conflict of interest.

The law firm Marshall, Parker and Weber has written a Nursing Home Guide that provides in-depth information about how to choose the right nursing home and get the best care there. (The Nursing Home Guide is free but registration is required.) The Guide can be accessed on the law firm’s website at https://www.paelderlaw.com/consumer-booklets/.