If you’re shopping for a nursing home for a parent or spouse, where you live matters more than you might think.
A new analysis of federal Medicare ratings finds that in some states, about half the nursing homes are solid choices. In others, families have far fewer good options.
The study, released this month by The Elder Justice Firm, looked at nursing homes in all 50 states. It counted how many earn four or five stars under Medicare’s rating system and have no abuse warning on their record. States were then ranked by the share of homes that meet both standards.
Hawaii came out on top. Nearly 3 in 5 of its nursing homes qualify. Wyoming came in last, with close to 40% of its facilities carrying a warning flag.
Gary P Guthrie
What Stands Out
Hawaii: the best odds at a high price. Hawaii has only 43 nursing homes, but 25 of them meet the standard. Staffing is a real strength, with almost 9 in 10 homes rated high in that category. The catch is cost. A private room runs a median of about $197,000 a year, near the top of the national range.
Arkansas: good quality and lower prices. Arkansas ranked second, and it may be the best value on the list. Half of its nursing homes are highly rated with no abuse warning, giving families more than 100 good options. A private room costs about $97,000 a year, roughly half the Hawaii price. Only about 1 in 20 homes carries a warning flag, the lowest share in the top 10.
Florida: lots of good choices. For the many retirees who already live in Florida or plan to move there, this one’s encouraging. The state has nearly 700 nursing homes, and 334 of them meet the standard. That’s more good options than any other state in the top 10. A private room runs about $146,000 a year.
New Jersey and New Hampshire round out the top five, each with close to half their homes making the cut and warning flags at fewer than 1 in 14 facilities.
One caution about the numbers: a high ranking doesn’t make every home in that state a good one, and a low ranking doesn’t make every home a bad one. Even in Hawaii, more than 4 in 10 homes didn’t meet the standard. The ranking tells you about your odds, not about the specific home down the street.
Stars Are Where You Start, Not Where You Stop
As reported by Smart Senior Daily, Medicare’s five-star ratings are useful, but they come mostly from inspection reports, staffing data, and information the facilities report themselves. They can’t tell you how a place feels at 6 p.m. on a Sunday.
The law firm behind the study makes the same point.
“A star rating is a good starting point, but it doesn’t replace a visit,” a legal expert from the firm said.
Here’s how to use the ratings and then go beyond them:
- Look up the home yourself. Medicare’s free Care Compare tool at medicare.gov/care-compare shows star ratings, staffing levels, inspection results, and any abuse citations for nearly every nursing home in the country.
- Check the staffing score on its own. The overall star rating can hide a weak staffing score, and staffing tends to affect daily life the most.
- Visit more than once. Go at mealtime and on a weekend afternoon, when staffing is often thinnest. Notice how quickly call lights get answered.
- Ask about turnover. Ask how many staff members left in the past year. High turnover often shows up in day-to-day care.
- Talk to other families. Relatives you meet in the lobby will usually be more candid than the brochure.
What It Costs (take a deep breath)
Across the states studied, a typical private room runs from about $90,000 to $220,000 a year. Medicare doesn’t cover long-term nursing home care, so most families pay out of pocket, use long-term care insurance, or eventually rely on Medicaid once savings run low.
If a nursing home could be in your family’s future, now is a good time to start learning how your state’s Medicaid rules work, well before you need them.
About this study: The analysis was conducted by The Elder Justice Firm, a law firm, using federal Medicare nursing home ratings. The full findings are available here.
