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FAQ: How We Rate Nursing Homes

By U.S. News & World Report

Nursing-home care can be as short as a few days or weeks after a hospitalization or for years if aging family members can no longer live on their own. To help find the best match for a loved one, U.S. News has evaluated nearly 16,000 facilities across the country. This FAQ explains the evaluations and responds to questions often posed by media and health care professionals.

Where can I find the ratings?

Best Nursing Homes allows you to search for a home by ZIP code.

Nursing Homes by Location allows you to select a state, region or metro area for your search.

Nursing Homes Search allows you to search for a nursing home by name.

Why does U.S. News rate nursing homes?

On any given morning this year, roughly 1.4 million individuals, including 1 in 10 individuals ages 85 and above, will wake up in a U.S. nursing home. We want to help families find a good and caring facility.

How is Best Nursing Homes organized?

Each nursing home receives an overall rating of one to five stars based on the number of stars in three categories: state-conducted health inspections, how much time nurses spend with residents and the quality of medical care. Facilities in all 50 states and the District of Columbia are included. Best Nursing Homes groups facilities in a given state or city into tiers by overall star rating — all five-star homes, all four-star homes and so on. Homes that are too new to receive an overall rating appear below one-star homes. Within tiers, homes are listed alphabetically.

On Best Nursing Homes, users can limit their searches in various ways, for example by distance or religious affiliation.

What is the source of the data? Data for Best Nursing Homes 2015 came from the federal Centers for Medicare & Medicaid Services, which oversees federal payments to nursing homes, in February 2015. CMS assigned the star ratings described above.

Which facilities did best in 2015?

In February 2015, 3,392 nursing homes earned an overall rating of five stars. Their profiles on usnews.com display a badge recognizing this status. U.S. News periodically updates the ratings and other data as new data become available from CMS, but only those homes recognized in February will display a badge throughout 2015. U.S. News delayed the release of the 2015 ratings from January to February because of significant CMS changes in the methodology that produces star ratings. The changes took effect in February.

How are health inspections, nurse staffing and quality measures evaluated?

Health inspections. Because almost all nursing homes accept Medicare, Medicaid or both, they are regulated by the federal government as well as by the states in which they operate. State survey teams generally conduct health inspections on behalf of CMS every 12 to 15 months. They also investigate complaints from residents, their families and other members of the public that have a health basis, broadly defined. Besides matters such as safety of food preparation and adequacy of infection control, health covers issues such as medication management, residents’ rights and quality of life and proper skin care. Ratings in this category are based on deficiencies and their seriousness and scope, meaning the relative number of residents who were or could have been affected. Deficiencies are included if identified during the three latest health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings are not factored into the CMS ratings. Best Nursing Homes displays all health and fire inspection results online.

Nurse staffing. CMS determines the daily time patients receive from the nursing staff, because even first-rate nurses and nurse aides can’t deliver quality care if there are too few. The information is self-reported by each nursing home. Facilities report the average number of registered nurses, licensed practical nurses, licensed vocational nurses and certified nurse aides and assistants on the payroll during the two weeks before the latest health inspection. The number of hours they worked is also reported. Agency temporary employees do not count. That information is compared with the average number of residents during the same period and crunched to determine the average number of daily minutes of nursing time. To receive five stars in the latest CMS ratings, the nursing staff had to provide nearly 4½ hours of care a day to each resident, including about 43 minutes from registered nurses. The time for each home is shown in the ratings. CMS also provides the average time physical therapists spend with residents, but that is not factored into the staffing rating.

Quality measures. CMS requires nursing homes to submit clinical data for the latest three calendar quarters that detail the status of each individual Medicare and Medicaid resident in 18 indicators. Examples of these include the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. Best Nursing Homes, like Nursing Home Compare, displays all 18 data points for each home. The ratings, however, are based on 11 — eight for long-term and three for short-term residents — considered the most valid and reliable, such as the two examples cited above and other measures related to pain, bedsores and mobility.

Are the highest-rated nursing homes necessarily the best choice?

No. CMS is adamant in cautioning that all ratings, whether good or bad, are just a starting point, and we agree. Nothing takes the place of in-depth visits. You can ask questions, observe residents and their families and caregivers, and get a feel of a home that stars can’t communicate. CMS says on its website that “there are many satisfied residents and families of residents in nursing homes … at the one-star level.” And CMS cautions that “no resident should be moved solely on the basis of a nursing home’s ratings … [Transferring] your loved one to a facility that has a higher rating should be balanced with the possible challenges of adjusting to a new nursing home.” That is one of many hard truths about finding a home where someone you hold dear can find good care.

Why doesn’t U.S. News rate retirement or assisted-living communities?

The cost of living in retirement or assisted-living communities is not covered by Medicare or Medicaid so they are not regulated by CMS; good data that would make evaluation possible are therefore unavailable.

More from U.S. News

How to Help Aging Parents Manage Medications

7 Red Flags to Watch for When Choosing a Nursing Home

How to Prepare for Hip Replacement Surgery

FAQ: How We Rate Nursing Homes originally appeared on usnews.com

Update 03/05/15: This article was originally published on Feb. 26, 2014 and has been updated to reflect policy changes.

Don’t Settle for Student Loans to Pay for Online Education

By WTOP Staff
Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
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