8 Nursing Home Pitfalls to Avoid

With an increasing aging population, being able to evaluate nursing homes on important issues is an essential skill for caregivers and children with aging parents. When one considers that their loved one might need a nursing home for either a short-term rehabilitation or more long term caregiving needs, one must realize that not all nursing homes are considered equal, and one must be able to differentiate between the good ones versus the unsafe profit-making ones. With more than 16,000 nursing homes in the US, there are several factors to consider.

In order for nursing homes to receive Medicare and Medicaid funds, they must pass health and safety inspections. The worst nursing homes will consistently fail to meet these standards, and will be given violations. These violations are accessible to the public, and one can actually compare local nursing homes via the Medicare website.

The Medicare Nursing Home Compare website will rate nursing homes on safety standards as well as availability of staff (patient to staff ratios). Consider the fact that a nursing home might meet all safety and health standards from an environmental perspective, but if there are insufficient staff available to answer call lights, assist patients to the bathroom, or provide necessary nursing care, the residents will suffer. Nursing homes must report staffing levels of registered nurses, licensed practical nurses, and nursing assistants to the government. The best nursing homes have administrators willing to pay for sufficient staff to best meet residents’ needs. There is no current federal standard for the minimum safe nurse to patient ratios.

Quality Measures

The website will also compare “quality measures” of nursing homes which are based on actual data submitted to Medicare. Some of the quality measures of nursing homes include…

1. Falls – Every year one in three older adults have a fall; for residents of nursing home, one third of these fall events result in a patient injury. Good nursing homes take proactive steps to prevent falls and supply adequate staff to prevent falls.


2. Urinary Tract Infections – The percentage of nursing home residents that develop a urinary tract infection directly relates to poor hygiene and toileting. The best nursing homes have lower incidences of UTI’s.


3. Moderate to Severe Pain – Long term residents who have unresolved moderate to severe pain complaints is another quality measure for nursing homes. Untreated pain leads to a poor quality of life and can cause decreased functional abilities, decreased mobility, decreased nutrition, depression, and overall poor health status. Having adequate nursing staff to assess and treat pain with medications and non-pharmacologic interventions is essential.


4. Pressure Ulcers – The worst facilities will have higher incidences of residents with pressure ulcers, if residents are not being turned and moved properly in bed, usually due to inadequate staff. Residents who develop pressure ulcers must be properly treated to ensure healing and this will require facilities to purchase proper dressings to cover the wound to prevent infection. Read more information on preventing and treating pressure ulcers.


5. Incontinence – Losing control of one’s bowel or bladder function can be due to an underlying cause that can be corrected. Residents who lose control of their bladders must have a plan in place to help them, including a regular toileting program. Incontinence puts residents at risk for skin breakdown and pressure ulcers if proper hygiene and skin care is not provided regularly by the facility staff.


6. Malnutrition/ Weight loss – How many residents demonstrated significant weight loss during the review period? If a higher percentage of residents are losing weight and malnourished, it may indicate that the facilities’ food is inadequate, or residents are not being fed properly. Weight loss can also be related to medical conditions such as untreated illness or depression. Generally no resident should lose more than 5% of their body weight in a month.


7. Restraints and Antipsychotic medications – Residents should never be put in restraints as a punishment, or to make things easier for the staff. Residents should also not be inappropriately medicated with antipsychotic medications, which can be harmful to the elderly, in order to chemically restrain patients by sedating them. Providing additional staff is one way to deal with patient behavioral problems. Only a doctor can order restraints for a medical reason.


8. Depression – Nursing home residents have high risk for developing depression and anxiety due to relocation, health concerns, loss, and isolation. Proper treatment for residents with depressive symptoms includes medication, social activities, and therapy. The worst facilities will have high percentages of depressed residents who are not being properly treated for their depression.

The Next Step

Once you’ve targeted your search a bit more, visiting each nursing home is the next step. Bringing a list of questions to ask will help ensure that you will get the information you need to make an informed decision.  Plan to ask questions of the director, as well as individual nurses and residents and compare answers. Nurses should be asked how many patients they are responsible for caring for that day to get an idea of nurse-to-patient ratios and how they compare in different facilities. Nurses can also be asked if they feel this is a safe number considering the patient’s needs, and if they have adequate support and supplies at the facility. Residents in public areas like hallways and dining rooms can be asked about their experiences and perceptions of the facility. Download this extremely helpful checklist of questions to ask during your visit.
Here are some additional questions to consider:

• Is the facility clean? Does it have a bad odor?
• How many citations did the facility have on their last inspection?
• Is the facility local or family-run or is it operated by a large profit making chain?
• Are the residents clean and well-dressed?
• Are there social events and activities for residents? Is there an activities calendar posted?
• How is the food and menu available? Ask to eat a meal at the facility.
• Are confused residents left in the hallways alone? Are there residents calling out?
• Do the staff treat the residents with respect and care?

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8 Nursing Home Pitfalls to Avoid