Adults often find themselves in the unenviable position of making long-term decisions on behalf of their aging parents or other loved ones. And one of the more difficult decisions can be choosing if and when a family member should be cared for by strangers, essentially. Choosing the right nursing home is not an easy task, and it is not something that most people look forward to. But once you’ve reconciled with the idea that structured care is the best option for you and your family, the next step is gathering the facts and establishing trust with the people – and the company – ultimately responsible for providing, and ensuring, a good quality living arrangement for your loved one. Like most things in life, preparation is the key to success, anticipating the tiny bumps that you might encounter along the road.

In the grand scheme of things, it would seem the most daunting aspect of choosing the right home is less about the actual decision as it is the process of making it a reality. It’s especially difficult when one hears so frequently about the mismanaged homes, preventable accidents, nursing home staff negligence and doctor negligence that have led to lawsuits. Many people faced with making a nursing home decision for the first time don’t know much about the industry, facilities, and available care, and they might not know the right questions to ask or the right data to study. Thankfully, several resources provide helpful ways to make such a daunting decision a little more simple, providing you with details to help make the most informed decision possible.

Nursing Home Compare
This online resource, courtesy of the Federal Government, offers detailed information about every Medicare and Medicaid certified nursing home in the country, providing access to a host of databases that authenticate and/or detail things like internal ratings. Nursing Home Compare also provides its own downloadable 50-plus-page guide to choosing a nursing home. Learn more about payment methods, certifications, licenses, fees, and resident rights.

ProPublica
As a non-profit, this national newsroom keeps tabs on threats to public interests by providing articles and information on the things you might not read anywhere else. ProPublica describes itself as focusing on stories with a so-called “moral force,” producing journalism that “shines a light on exploitation of the weak by the strong.” ProPublica founded Nursing Home Inspect in 2012, a collection of data from the U.S. Centers for Medicare and Medicaid services. One app identifies which states have been subject to significant fines by regulators because of deficiencies. Shockingly, some fines run upwards of $40,000!

Eden Alternative
The Eden Alternatives maintains a philosophy that elder care is not a “one way street,” treating the process of care as more of a collaborative effort. “Education is the antidote to fear,” according to the organization’s consumer guide. This guiding principal perhaps sets Eden’s alternative above the rest, emphasizing transparency and education as two of the most important factors when choosing a residence. You can find consultation services, webinars, and a calendar listing of events with guest speakers, discussing a range of topics like community engagement and the improvement of a quality culture.

Agency for Healthcare Research and Quality
The AHRQ, a division of the U.S. Department of Health and Human Services, provides a number of helpful resources for your search. This includes information on Medicare and Medicaid services, national surveys related to nursing homes, and links to reports on nursing home trends from organizations like the National Citizens’ Coalition for Nursing Home Reform, one of which collects a range of data on nursing homes around the country based on required surveys.

Nursing home resident Edna Irvin became the source of controversy late last year. The 80-year-old Irvin, a guest of the Chenal Heights Health and Rehabilitation Center in Little Rock, Arkansas, was the featured anecdote in an eye opening-read from the Center for Public Integrity. The Center found widespread reporting discrepancies among nursing homes in the U.S., including the home where Irvin had been living.

Based on several accounts and an analysis of government resources, the CPI discovered a laundry list of inflated, self-reported staffing numbers, some of which had been recorded just weeks prior to federally mandated inspections. The article points out that Irvin was a victim of a flawed system.

Over the first few months since she began living at the residence, Irvin endured a series of mishaps and injuries, according to the article. She suffered a laceration to her head related to a fall and fought through a severe bowel obstruction. In a later medical report, a rehab nurse noted that Irvin had traces of bacteria in her intestine and did not receive appropriate care for the obstruction. A law firm, acting on behalf of Irvin, obtained the nurse’s documents for an impending lawsuit filed by Irvin’s daughter, Lisa Sanders.

Sanders eventually had her mother transferred to a new facility, only after learning disturbing details about the staff, the home’s hours of operation, and the method by which the home monitored its residents. She discovered some wildly inaccurate numbers, a shock that ultimately set the move and the lawsuit in motion.

Irvin’s story is not unusual. The Center for Public Integrity uncovered an all too common if not systemic problem that has plagued nursing homes for many years. The process of self-reported data has been widely criticized by government agencies and the public, not least for its lax standards and shoddy reporting. Almost 100 peer-reviewed, academic studies, according to the Center for Public Integrity, showed that the amount of care was most strongly connected to quality care; lower levels of care showed higher risk for injury and, in some cases, death. By skewing the numbers, homes are, inadvertently or not, perpetuating bad practice and misleading prospective residents about the care they should be receiving.

The Center for Public Integrity also pointed out that self-reported data has historically been a crucial metric for government agencies that rank homes based on staff numbers, a metric that often helps the public make consequential decisions on behalf of their loved ones. But relying on self-reported information comes with a price. Irvin paid the price, and now her case is in the hands of litigators.

Improvements have been made since 2010, resulting from a provision in the Affordable Care Act that requires many homes to change from a self-reporting method to a payroll-based method. The payroll-based system utilizes an electronic data collection system—practically standard in today’s digital world—that ensures more accurate tracking. But if anything, the report by the Center for Public Integrity reminds us that there’s much more to be done.

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