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Nursing homes can vary drastically in quality

by Carol Bradley Bursack, Editor-in-Chief

The good news is that, in general, nursing homes are improving. They are responding to pressure from families and the huge Boomer generation to become more person-centered and responsive to individual needs. The bad news is that all nursing homes haven't improved. Location makes a difference. The inconsistency of nursing home care is troubling. Touring all of the homes in the area you are considering is a good idea. Even then, state regulations mean a lot, and some states aren't doing what they should in this area.

My family was fortunate. Because at one time I had five elders as well as two children who needed my care, and three of those elders needed skilled nursing care, there was little choice but to look into nursing homes. My community happens to have some very good facilities, and one of the finest is just two blocks from my home. As I said, we were fortunate. It's true that all of our elders' money went into nursing home care, but that's what it was for. The care was good to excellent. We can't complain. is a site the government set up a couple of years ago to help people choose nursing homes through a rating of one to five stars. This is an admirable try, and certainly a decent tool. However, it's only a tool. So much depends on the state's standards where the home is located, plus the general competition since some of the criteria is self reported, that the tool should be taken within the context of other homes in the community.

In other words, a home with two stars in one state could get five in another, because the standards are lower in the second state.

When I was speaking to a college gerontology class recently, one of the students told an interesting story. She works as a Certified Nursing Assistant at a local home near the college, but she is from a different part of the country. She said that one nursing home in her home town has a waiting list of months. It's considered the cream of the crop. However, she said, that home - the very best in her state - isn't even as good as the worst in the state where she is going to school. I found that an eye opener.

The good work of forward-looking people who find good care rewarding, and consider it a moral responsibility, are making inroads around the country. But there are still states where even the best care homes are relatively poor.

I received an email from a woman who said her father, who has Alzheimer's, was being served consistently a peanut butter sandwich and a glass of water for "supper." The home had a menu posted to comply with state law, but obviously the home, and state regulators, were not following through.

Normally, when people have complaints about a nursing home, I suggest that they go through the ranks, starting with the CNA who provides their loved one with hands-on care. Then, if nothing improves, move on to the floor nurse, the home administrator and eventually the state ombudsman to get action if necessary. In this case, I suggested that the woman go directly to the state ombudsman.

Every state has an ombudsman who is independent of the nursing homes and is charged with the duty of following up on complaints by families of vulnerable people in nursing homes. You can find your state's nursing home ombudsman by going onto your state's Web site and looking under aging services or a related name. You could also find the information by going to the National Long-Term Care Ombudsman Resource Center. Here you type in the locality of the nursing home and you will find contact information for the ombudsman.

Overall, we are our elders' best advocate. If you don't have the most wonderful nursing homes in your community that means you will have to be extra vigilant.

  • I still recommend you start out with a friendly, appreciative attitude toward the nursing home staff, and try to be a team player.
  • Make it very obvious that you are part of the care team and you, another family member and/or friends will be seeing your elder often.
  • Assure your elder that you are there for him or her. Then keep an open mind, while you keep your eyes open.
  • Be realistic in your expectations. Unfortunately, nationwide, we aren't in a place where nursing homes are dream locations. There are some that are very, very good. There are many that are okay. And there are still some that are dreadful. Compare, research, ask questions and then determine if your expectations are for one-on-one care when that isn't possible, or if you are being realistic.
  • It's not too much to expect that your elder be kept clean and dry, given decent food, activities that are appropriate and handled with kindness and compassion.

How I wish all nursing homes were wonderful! The home my elders' spent so much time in was good then, but better now. I know the administrator and the owners well enough to know the home will just keep improving. Not everyone is so fortunate. We need to push for better care for our elders, even as we enjoy the progress that has been made. We are the advocates.