Life’s Difficult Decisions: Choosing a Nursing Home for a Loved One

Posted on January 10, 2017 by

photo of elderly hands on a keyboardEvery year, millions of Americans seek care in nursing homes. If you or a close friend or family member are in this position, how would you choose the right one?

Fortunately, the government runs a website called Nursing Home Compare, which has information that is meant to help people research and compare nursing homes. While the website is generally helpful to people, we found some ways it could be improved. Today’s WatchBlog looks at Nursing Home Compare—and its Five-Star Rating System.

Comparing Nursing Home Quality

Choosing a nursing home for a loved one can be stressful. Often times the decision needs to be made quickly, and finding reliable information can be tough.

To help assist people with this difficult choice, the Centers for Medicare & Medicaid Services (CMS) created the Nursing Home Compare website in 1998. The website contains nursing home information, such as:

  • Health inspection ratings,
  • Ratio of nursing staff to residents,
  • Performance quality measures, and
  • Number of registered complaints against the home.

The Five-Star Quality Rating System

As of 2008, the Nursing Home Compare website also contains a tool called the Five-Star Quality Rating System. Based on a calculation involving the bulleted information above, the Five-Star System assigns each participating nursing home an overall star rating, ranging from 1 (below average) to 5 (above average).

Helpful Tips When Using Nursing Home Compare

We found that people think the website is a helpful starting place for finding a nursing home, and that it can provide valuable information. That said, people shouldn’t rely solely on the website when making such an important decision.

There are a few important weaknesses to consider. For example, the overall star rating can’t be compared nationally, but only within states. This means if you live in a town that borders multiple states, you don’t know if a 4-star home in one state is better than a 3-star home in another state. The figure below shows how this could cause problems.

Table 3: Stakeholder Responses to How Much Consumers Use Nursing Home Compare(Excerpted from  GAO-17-61)
[Image updated to reflect state-related issues. Check out the full report for
all of the images.]

Example of Consumer Making Nursing Home Decision across Multiple States

Another thing to consider is that the information and star rating provided on the website are often outdated, and may not reflect the current status of the nursing home. CMS encourages people to explore other sources of information about the nursing home, including an in-person visit to the home.

For more information about what groups found helpful (and not helpful) about Nursing Home Compare, read our full report. We also made several recommendations to CMS about how they could improve the website.

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Housing for Homeless Veterans through VA’s Enhanced-Use Lease Program (interactive graphics)

Posted on January 4, 2017 by

GAO graphics iconApproximately 39,000 U.S. veterans were homeless as of January 2016 due to factors such as mental health issues and substance abuse. The Department of Veterans Affairs’ enhanced-use lease program turns unused federal buildings into affordable housing for homeless veterans.

This housing comes with crucial supportive services, including access to medical care, mental health counseling, substance abuse treatment, and assistance with transportation.

The Department of Veterans Affairs' 70 Enhanced-Use Leases, as of September 2016

Our recent interactive graphics shows each state’s homeless veteran population, as well as the current and future location and status of enhanced-use leasing units. To interact with these graphics, visit the full report page.

 

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Reflections on Addiction and Recovery (videos)

Posted on December 22, 2016 by

GAO_Video_icon-largeOver 47,000 people died of drug overdoses in the United States in 2014—more than any previous year on record. In fact, drug overdoses are now the leading cause of death by injury in the country, surpassing auto accidents.

To help policymakers and the public understand drug abuse—including misuse of prescription drugs—and what can be done to address it, we added Illicit Drug Use to our collection of Key Issues. This new Key Issues page provides bottom line information about the issue and links to our key reports on the topic, including the results of our 2016 forum on strategies to prevent illicit drug use.

In order to illustrate the impact of illicit drug use on individuals and families, the forum began with two video testimonials of individuals who are in recovery from a substance abuse disorder—discussing how they started using drugs and their paths to recovery. Watch their stories:

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Nursing Home Compare Website (podcast)

Posted on December 21, 2016 by

GAO Podcast IconAbout 1.4 million Americans seek care in nursing homes every year. To help them—and their families—make informed choices about selecting the right one, the Nursing Home Compare website allows people to research nursing homes using a Five-Star Quality Rating System.

A team led by Nikki Clowers, Managing Director in our Health Care team, recently assessed the website and rating system to see how useful they were to consumers. Listen to what they found:

 

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Student Loan Income-driven Repayment Plans (podcast)

Posted on December 20, 2016 by

GAO Podcast IconIncome-driven repayment (IDR) plans can help borrowers who are struggling to repay their student loans. These plans allow federal student loan borrowers to make lower payments over longer periods of time based on their income. At the end of the repayment term, if there is any remaining balance in a loan that is being paid through an IDR plan, the balance is forgiven. The Department of Education estimated that these repayment plans will ultimately cost the federal government $74 billion— we think they may be under or over by billions.

A team led by Melissa Emrey-Arras, a director in our Education, Workforce, and Income Security team, recently looked into how Education came up with its estimate. Listen to Melissa explain:

 

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Prescription Drug Labeling for Individuals Who are Blind or Visually Impaired (podcast)

Posted on December 19, 2016 by

GAO Podcast IconAbout 7.4 million Americans are blind or visually impaired, and they may have trouble reading the labels on prescription drug containers. Accessible labels—including audible, Braille, and large-print labels—can help. In 2013 the government developed best practices for accessible labels, and conducted outreach to pharmacies about them.

A team led by John Dicken, a director in our Health Care team, recently looked at the extent to which pharmacies have implemented these best practices. Hear what they found:

 

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GAO Again Named Among Best Places to Work and #1 for Our Support of Diversity

Posted on December 16, 2016 by

Banner: best places to work in the federal government

The Partnership for Public Service announced that GAO has again placed on its roster of the Best Places to Work in the Federal Government. This year, we rose to 2nd among mid-size agencies, tying with Peace Corps for that honor.

And, for the 3rd year in a row, we ranked #1 in our support of diversity among mid-size agencies.

U.S. Comptroller General Gene L. Dodaro commented on the rankings:

GAO has long been known as a terrific place to serve the public in a positive work environment. The Partnership’s 2016 rankings validate our reputation as a leading employer.

We have a great fact-based, non-partisan mission and an outstanding workforce that is deeply committed to helping government work better and to holding agencies and programs accountable.

I’m also heartened that GAO’s commitment to diversity and inclusion is reflected in continuing high scores in that area.

Read our press release here and learn more about GAO’s work in these WatchBlog posts.

• Questions on the content of this post? Contact Chuck Young at youngc1@gao.gov.
• Comments on GAO’s WatchBlog? Contact blog@gao.gov.

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Zika Virus Prevention and Response (infographic)

Posted on December 15, 2016 by

The Zika virusinfographic thumbnail can cause symptoms including fever, rash, and joint pain. It has recently been linked to microcephaly in newborn babies and is possibly linked to Guillain-Barré syndrome in adults. The disease first started in the tropics, then individual travelers were diagnosed in many parts of the country. Subsequently it spread locally in parts of Florida and Texas. Continue reading →

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Rural Challenges, Federal Responses

Posted on December 13, 2016 by

photo of a rural houseMoving to a small quiet town surrounded by nature holds appeal for many Americans. However, there are a number of unique challenges to living and working in rural communities, including purchasing homes, building in high-risk areas, and accessing high-speed Internet service.

Today’s WatchBlog explores how the federal government is assisting rural communities with these challenges. Continue reading →

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Getting a Good Deal — How to Do Federal Contracting Right

Posted on December 9, 2016 by

photo of hardhat and blueprintsOliver Hart and Bengt Holmström won the 2016 Nobel Prize for Economics for their contributions to contract theory—which looks at how contract incentives help resolve conflicts of interest between parties.

And, as anyone who’s hired a contractor knows, ensuring that a job is done right (and that you get a good deal) isn’t always easy. In fact, we see these challenges all the time in our work—the federal government bought about $440 billion of goods and services in recent years—and we urge agencies to follow good contracting principles to save money and get better outcomes. Continue reading →

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