Medicare's role in protecting nursing home patients
When you hear about Medicare, you probably think of the federal program that helps pay for older adults’ health care. What you may not realize is that another of Medicare’s major responsibilities is to inspect health care facilities to make sure that patients receive safe and high-quality care.
Among those facilities are the nation’s more than 15,000 nursing homes.
Nursing facilities wanting to get reimbursed for treating Medicare patients must be certified as meeting certain health and safety requirements. The federal agency that oversees Medicare – the U.S. Centers for Medicare and Medicaid Services – works closely with the states to accomplish that.
Trained health professionals make unannounced visits to nursing homes to check whether the health and safety standards are being met and, if not met, to ensure the problems are addressed. An inspection is often the result of a complaint lodged by a patient or family member.
Nursing homes that don’t promptly correct their shortcomings may be subject to fines. If the health and safety violations persist and pose a serious enough threat to patients, the facilities may be terminated from the Medicare program and forbidden to bill the government for patient care.
Unless and until a nursing home actually loses its Medicare funding, this regulatory process often goes unnoticed by the general public. But you can see how the nursing homes in your community have fared in recent health and safety inspections by visiting Medicare’s Nursing Home Compare website.
Besides providing detailed information on inspections, the website reports on facilities’ staffing and such quality measures as whether residents are in pain or losing weight. The site uses a five-star rating system to help you understand the differences in the quality of care between nursing homes.
Families must often search for a nursing home for a spouse or parent at a moment’s notice, after some crisis or emergency. With little time to spare, many turn to Nursing Home Compare to begin their research. The website receives more than 1 million visits every year.
The website enjoys a solid reputation among consumers, having been revised over the years to make it even more trustworthy and user-friendly. Facilities can be searched by city, county, state or ZIP code.
As helpful as those online comparisons are, Nursing Home Compare isn’t meant to be the final word on the subject. It’s just one guide to use when looking for a nursing facility.
If you’re the one who’s been hospitalized, your physician, discharge planner or social worker can help identify an appropriate facility for your recovery.
If you’re the one assisting a spouse or parent about to enter a nursing facility, you also might:
- Ask for recommendations from friends, family or neighbors who may have had a loved one in a nursing home.
- Call your state’s long-term care ombudsman to find out how many complaints have been filed against particular nursing homes, what kind of complaints they were and whether they were resolved. In Texas, the ombudsman’s number is 1-800-252-2412.
- Visit the nursing homes that interest you. Make an appointment and think of the questions that are important to you. Nursing Home Compare contains a helpful checklist of questions that covers everything from care and safety to activities and food.
When you or a family member become a patient in a nursing home, you have a right to expect the facility will comply with Medicare’s health and safety standards. The thousands of unannounced inspections done each year by federal and state surveyors put teeth in those standards and hold rule-breakers accountable.
This regulatory process aims to call out the poor performers and bring them back in compliance. It is a vital mission for Medicare.
For more tips on selecting a nursing home, visit the Nursing Home Compare website or call Medicare’s 24-7 customer service line at 1-800-633-4227. A free Medicare publication, a “Guide to Choosing a Nursing Home,” can also be downloaded from the website or requested by phone.