Choosing a Nursing Home in Delaware County: What the Ratings Do Not Tell You

Read the surveys, not the stars

Star ratings compress a great deal into one number, and a portion of the underlying data is self reported. The inspection survey reports underneath are far more useful: they describe what inspectors actually found, in specific terms, with dates.

Look for patterns rather than isolated findings. Every facility has deficiencies. Repeated citations for the same thing, particularly staffing, pressure sores, falls or infection control, tell you what daily life is like.

Staffing is the number that predicts everything

Look at payroll based staffing data, which is auditable rather than self declared, and specifically at hours per resident per day and at weekend levels, which often fall sharply. Turnover matters as much as headcount: a facility that cannot keep staff is one where nobody knows your relative.

Visit at the wrong time

A scheduled tour shows you the facility at its best. Visit unannounced on a weekend evening, or around 6am, or at a mealtime.

What to notice:

• How long call bells ring before anyone comes.
• Whether residents needing help to eat are being helped, or whether trays are collected untouched.
• Whether residents are dressed, clean and out of bed.
• Smell. A persistent urine smell is a care problem, not a building problem.
• Whether staff know residents by name and speak to them rather than about them.
• How many staff you can actually see on the floor.

Questions worth asking

• What is the direct care staffing ratio on days, evenings, nights and weekends?
• What is annual turnover for aides?
• How much agency staffing is used?
• Is there a nurse on site overnight?
• What is the process when a resident’s needs increase?
• Who owns the facility, and are there other homes in the group?

Read the admission paperwork before signing

Look specifically for an arbitration agreement. It is often presented as routine, sometimes during the most stressful week of a family’s year, and it can affect where a future dispute is decided. Ask whether admission is conditional on signing it, and ask for time to read it.