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How to Find a Quality Nursing Home During COVID-19

Nursing home visitation during COVID-19.

 Wanderluster / Getty Images

Key Takeaways

  • U.S. News & World Report recently released its ratings on nursing homes, which includes COVID-19 data.
  • Experts suggest avoiding nursing homes during the pandemic if at all possible.
  • If you must find a facility, you can evaluate the quality of a nursing home by examining a variety of factors, such as community COVID-19 outbreak data and visitation policies.

The novel COVID-19 hit nursing homes hard this year—making it especially difficult for people attempting to choose a nursing home during this time. What should you look for if you’re looking for a nursing home, especially in the age of COVID-19?

To help with the decision, U.S. News and World Report recently released its annual Best Nursing Homes rankings. The rankings include more than 15,000 nursing homes and separate ratings for short-term rehabilitation care and long-term chronic care facilities.

This year U.S. News also included information on:

  • COVID-19 infection ranks
  • Vaccination rates for flu and pneumonia
  • Infection control violations

California is the highest number on the list, with 215 nursing homes that received a high performing rating in short-term rehabilitation and 135 designated as high performing in long-term care, followed by Florida, Illinois, and New Jersey.

Hawaii, Maine, and Alaska have the highest proportion of best nursing homes with at least half of all Medicare or Medicaid certified nursing homes in these states receiving a high-performing designation in either short-term rehabilitation or long-term care, or both, according to U.S. News.

Should You Look for a Nursing Home Right Now?

Waseem Ghannam, MD, CEO and co-founder of Telehealth Solution in North Carolina, doesn’t think this a good year for assessing nursing home quality because many nursing homes are dealing with staff shortages due to COVID-19.

“If anything, this was a good year for nursing home emergency preparedness evaluation,” he tells Verywell.

Vincent Mor, PhD, a professor of health services, policy, and practice at the Brown University School of Public Health in Rhode Island, tells Verywell that the best predictor of COVID-19 cases in a nursing home is the prevalence of the virus in the communities where the staff work, because they are the primary vectors.

“Last spring’s experience is not necessarily a good predictor of how nursing facilities are handling the current re-emergence of the virus,” Mor says.

Eleanor Feldman Barbera, PhD, an aging and mental health specialist in New York, agrees.

“The COVID-19 rates have been shown to reflect the spread of the illness in the community rather than the quality of the nursing home, so I wouldn’t recommend using that as a litmus test,” she tells Verywell. “I would continue to use the CMS Five Star Quality Rating System.” 

Charlene Harrington, PhD, RN, a professor emeritus at University of California San Francisco who has studied COVID-19 and nursing homes, also advises people to use the CMS Nursing Home Rating system as well as data on COVID-19 in each facility. She tells Verywell people should avoid putting a loved one in a nursing home, as it’s “not the time to take a chance on going to one.”

CMS Five Star Quality Rating System is a rating system created by the Centers for Medicare and Medicaid Services that gives each nursing home a rating of between 1 and 5 stars. 

Harrington says many nursing homes may not be reporting their COVID-19 statistics accurately, which can make it difficult to choose a safe facility during this time.

“People needing post-acute rehab should get that at home,” Harrington says. “People needing long-term care should also try to stay at home and get caregivers to come into the home during the pandemic.”

What This Means For You

If looking for a nursing home for yourself or a loved one, it's important to consider a variety of factors, such as nurse-to-patient staffing ratio, community COVID-19 outbreak data, communications technology and practices, and visitation policies.

What to Look For in a Nursing Home

If you’re looking to assess potential nursing homes for yourself or a loved one, here are a few expert tips.

Examine Your Needs for a Nursing Home

Examine why you may need to use a nursing home, whether that’s for a short- or long-term need, Mor suggests.

“Few people think that they’ll be a nursing home forever, but it’s not unusual to enter a home for rehab and remain there,” Mor says. “The best research suggests that you should choose a facility that has a high rate of discharge to the community if that is what is desired.”

Research Stats

Ghannam suggests looking into certain rates and percentages associated with the facility, including:

  • Nurse-to-patient staffing ratio
  • 30-day readmission rates
  • Staffing data
  • Bed ulcer percentages

“The most important issue is what the nurse and the total staffing levels are in the nursing homes,” Harrington says. According to Harrington, there should be at least 4.1 total nursing hours per resident data including .75 RN hours (45 minutes) per resident a day—and even higher when there is increased need from the resident.

You should also look into how often the medical director comes into the building and the facility’s emergency preparedness plan, as well as their plan to combat isolationism in seniors. Grannam says you should ask about any care-related recent citations, and if there were citations, look into the corrective measures taken.

Evaluate COVID-19 response

For issues specific to the pandemic, you may want to ask about when and how the COVID-19 vaccine will be made available once released, and if they have a unit for patients who have the disease or for whom the vaccination didn’t work, Grannam says.

“It is an essential time to pay close attention to a facility's track record not only for infection control, but for staffing—because problems in these areas can leave residents especially vulnerable to the virus,” Mike Dark, a staff attorney at the California Advocates for Nursing Home Reform, tells Verywell.

Dark suggests inquiring about adequate staffing.

“Have they applied for waivers to regulations imposing minimum staffing requirements?" he says. "During the pandemic having adequate and well-trained staff is essential for the survival of residents."

When looking into citations, ask about any pertaining specifically to COVID-19.

“While agencies have begun to issue new rules and regulations intended to mitigate the spread of COVID-19, states have not done a great job enforcing these new rules," Dark says. "See whether your agencies are actually issuing citations to facilities that are not following the rules."

People evaluating nursing homes should ask about the facility’s visitation policy, Dark says. “COVID-based visitation restrictions are likely to be with us for many months, and access by family and friends to residents can be a matter of life and death,” he adds.

Given the current situation, Barbera recommends looking into a facility that allows safe family visits, such as window visiting areas or outdoor spaces. People should also evaluate how communication works in terms of getting information to and from family members and how staff assists residents with video chats and phone calls if they're unable to manage it on their own.

“Sadly, placing a loved one in a nursing home right now means a high likelihood of not being able to see them in person for quite a while,” Barbera says. “I’d make sure they have a telephone they know how to use and have the phone and the charger labeled. It makes a huge difference to be able to keep in touch with family members by telephone."

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  1. Cision. U.S. News names best nursing homes for 2020-21. Updated October 27, 2020.