Nursing home report: be careful!

Consumer Reports has a new report on the quality of care at nursing homes. Among the findings:

• Not-for-profit nursing homes are more likely to provide good care than for-profits, based on our analysis of inspection surveys, staffing, and quality indicators.


• The same analysis shows that independently run homes are more likely to provide good care than chains.


• Through its influence in politics, the industry has whittled down the protections of the 1987 nursing home reform law.

In addition to general findings, the report includes a state-by-state Quality Monitor list of nursing homes more likely to provide better quality care and facilities that should be avoided. There is also a list of the The Deficient Dozen, which are "homes noted for poor care on all five of our Lists". Fortunately, only one nursing home in the South appears on the list (it's in Georgia).

Also on a state-by-state basis, the report analyzes regulatory oversight and enforcement. Criteria include whether a state has the authority to fine nursing homes for violations, and how often those states fine consistently poor performers. The report also notes how cooperative states are in providing this information. Their conclusion is that families should be especially cautious in states where there is little regulatory oversight or enforcement.

Around the South, the report notes that North Carolina, Georgia, Alabama, and Mississippi have no regulatory authority to fine nursing home facilities for violations. Among Southern states that do have the authority, two (Tennessee and Kentucky) rank above average for exercising it, and two (South Carolina and Virginia) rank below. Florida, Arkansas, and Louisiana declined requests for information about regulatory enforcement.

Another section of the report talks about paying for nursing home care. According to the report:

Medicaid pays for about half of all stays in nursing homes. Long-term-care insurance covers a tiny amount-less than 10 percent of all stays. Families finance the remainder, paying out of their own pockets.

Chances are if your relative stays a long time in a nursing home, his or her financial resources will be quickly exhausted or "spent down." The resident will then be eligible for Medicaid, often within the first six months of residence in the facility.

This indicates that many seniors and disabled people are being driven into poverty before government aid is made available. I'm no expert on how all this works, but just from personal observation it's complicated trying to figure out what Medicare (and presumably Medicaid) will and won't pay for. The report covers some of this, and it's a complicated problem that most of us will face sooner or later.

On a policy related note, I believe Medicare does not pay for nursing home care at all. Some home-health services and supplies/equipment are covered, as are stays in rehab/transitional facilities. But Medicare basically does not provide for long-term care, nor does it provide for a level of home health care that would keep many "borderline" seniors out of nursing homes. This seems like a good case for supplemental long-term care insurance. It also seems like a good case for providing better Medicare coverage for assisted-living and home-health services.