What to look for when you’re picking a nursing home in KY (Hint: Location is key)
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Kentucky’s nursing home inspection backlog
Herald-Leader investigation shows more than half of Kentucky’s 269 nursing homes have gone two or more years since their last “annual” survey.
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‘They didn’t care.’ KY still faces huge backlog of long-overdue nursing home inspections
A new rule will make nursing homes hire more staff to improve care. Kentucky opposes it.
‘No quick fix.’ The Herald-Leader has reported on KY nursing home problems for many years
What to look for when you’re picking a nursing home in KY (Hint: Location is key)
When you’re looking for a nursing home for a loved one, you might not have a lot of time or choices.
Older or disabled hospital patients can be transferred to a nursing home on short notice. Even if you have weeks to deliberate on where to place someone, there might not be many nursing homes in your community with open beds that match your ability to pay.
You could face a waiting list.
“It is not a consumer’s world right now in terms of finding long-term care,” said Denise Wells, executive director of the Nursing Home Ombudsman Agency of the Bluegrass, a Lexington-based organization that serves as an advocate for nursing home residents and their families.
The Ombudsman Agency offers a detailed guide for Central Kentuckians trying to decide on their nursing home options.
More than anything else, consider a facility’s location, Wells said.
Will the nursing home be close enough to your home or job that you’ll be able to make regular visits? Not only will that lift your loved one’s spirits, it lets the staff know that you’re paying attention to how your loved one is treated, which makes a difference, Wells said.
“I always tell people that if you’re looking at two facilities, and one of them is a three-star facility 40 minutes from where you live and another is a two-star facility right in your town, go with the two-star facility,” she said.
“Because being able to check in on your loved one is going to be so important.”
Other actions you can take:
▪ Check the quality ratings on Nursing Home Compare, a website operated by the U.S. Centers for Medicare and Medicaid Services, or CMS, which funds the nursing home industry with federal dollars.
Nursing Home Compare rates every nursing home in the country on a five-star system. Five stars is “much above average,” four stars is “above average,” three stars is “average,” two stars is “below average” and one star is “much below average.”
Are you comfortable with a one-star or two-star facility?
Apart from ratings, there are symbols that show if abuse has been documented at a nursing home in the last two years or if it’s a “Special Focus Facility” that is supposed to get more scrutiny from regulators because of its troubled history of serious deficiencies.
The website can be searched by location (street address, city, state or ZIP code) or name of a facility. Plug in the name of your town and see which nursing homes operate locally.
Once you’ve selected a nursing home to research, you can do more than check its ratings on Nursing Home Compare.
Read the results of state inspections from the past three years to see what problems were found. You’ll likely see long, dense reports full of bureaucratic jargon, but keep your eyes peeled for “immediate jeopardy” violations, the worst kind.
Count the total number and the seriousness of deficiencies cited. Check the facility’s reported staffing levels and see how many hours of daily care the average resident gets.
One major warning: Much of the information on Nursing Home Compare comes from unannounced annual health inspections that are supposed to be conducted at every nursing home by the designated “state survey agency.”
In Kentucky, that’s the state Cabinet for Health and Family Services.
But the cabinet has fallen far behind schedule on its inspections since the COVID-19 pandemic in 2020. As of October, more than half of the state’s 269 nursing homes had gone from two to five years without a so-called “annual” inspection.
Those delays mean a lot of information on Nursing Home Compare is outdated. A facility that did well in its last inspection in 2021 might have nose-dived later, or vice versa, especially given high rates of staff turnover and how frequently nursing homes are passed around from one company to another.
Look for the date of the most recent “health inspection.” Was it more than a year ago? Several years ago? In the interim, the state might have conducted one or more “complaint inspections,” a quick visit focused on a complaint the state got about a specific problem. That’s not as good as a health inspection, but it’s better than nothing.
Ideally, you want a nursing home that state inspectors visited in the last year and gave a clean bill of health.
▪ Go inspect a nursing home for yourself.
Schedule a visit with the administrator. Then make a second visit without calling ahead. If you go at a mealtime, walk around the dining room to see what the food looks and smells like and if residents seem happy.
Speaking of smell, does the facility smell clean? Is the temperature comfortable? Do the staff treat residents and each other with courtesy?
“A lot of people say, ‘Oh, I wouldn’t know what to look for,’ but you really do,” said Wells of the Ombudsman Agency. “Once you set foot in the door, you can kind of tell. You can ask yourself, ‘Just looking around, is this the kind of place I would want to live?’”
CMS offers a great checklist of questions to ask during your visit that relate to the health and safety conditions inside a nursing home, costs and insurance coverage, the food and activities, and specialized care for conditions such as dementia. The National Institute on Aging also suggests a good set of questions.
Make sure you ask about staffing, which is a serious problem at many nursing homes. How many nurses — and what kinds (registered nurses, or RNs, typically have more medical training than licensed practical nurses, or LPNs) — are on duty on the premises during the days, evenings and nights? How many certified nursing assistants, or CNAs, who do much of the hands-on care? How much time do doctors spend at the facility to check on residents?
▪ Look for lawsuits.
Not every nursing home gets sued by residents or their families, and a lawsuit by itself is not proof of negligence, abuse, wrongful death or whatever other claims are made. But if a nursing home is sued many times — especially if the suits make similar claims and are filed by different law firms — that might set off alarms for you.
Lawsuits are probably going to be filed in the circuit court in the county where the nursing home operates.
The Kentucky state courts offer a public website where you can look up court documents, but you have to pay for access. For free, you can visit your local courthouse and ask at the circuit clerk’s office to use the public-access computer terminal. The deputy clerks can help you use that computer to look up lawsuits.
How often was the nursing home sued? For what reasons? Was the case dismissed or did it settle with a financial agreement or did it go to trial? What facts about the nursing home were disclosed as the case proceeded?
▪ Speaking of lawsuits, stop and read the arbitration agreement.
When you finally choose a nursing home, you’ll get a daunting stack of paperwork during the admissions process. One of these documents almost certainly will be a short form called a “binding arbitration agreement.”
Many experts suggest you don’t sign that — and you don’t have to, although that’s not always clearly understood.
Arbitration is a substitute for lawsuits that is favored by nursing homes and that the U.S. Supreme Court approved for their use after a number of challenges
When someone files a lawsuit against a nursing home, the details of their complaint are made public at the courthouse for everyone to review. (See the above section on checking litigation against nursing homes.)
If the case goes to trial, a jury of citizens hears the facts and decides what damages, if any, are appropriate. In most cases, plaintiffs don’t pay their lawyer unless they win, at which point the lawyer gets a share of that award.
In arbitration, complaints are handled privately. Both sides split the cost — often thousands of dollars — to hire an arbitrator, usually a lawyer, who hears the claims and issues a binding decision.
Even when they decide in favor of the plaintiff, arbitrators generally don’t award punitive damages, the large sums meant to punish bad behavior, as compared to compensatory damages, which tend to be much smaller.
Decide for yourself which method you would prefer to use in the event a dispute arises down the road.
This story was originally published December 9, 2024 at 4:00 AM.
