Nursing Homes 101 

Whether you’re looking for a nursing home for yourself or a loved one, here’s what you should know:

Nursing Homes 101: The Basics

Nursing homes have changed.

Nursing homes, also known as skilled nursing facilities, provide round-the-clock nursing and medical care required by older chronically ill or disabled people who are the sickest or most in need of assistance. There are about 15,000 nursing facilities today, down from 19,000 in the 1980s, after which states began funding more home- and community-based services.

Other types of facilities have gained prominence. Assisted-living facilities are for people who need help with daily care but not as much as provided in a nursing home. Continuing-care retirement communities offer different levels of care at different parts of their campuses – from hotel-like independent living wings to assisted living to memory care to traditional nursing home services.

They offer both long- and short-term care. The average stay is one year. While most residents live out their lives in nursing homes, people recovering, for example, from a stroke or a hip replacement often check in for short-term, rehabilitative stays. These rehabilitative stays are generally covered by Medicare, which pays for up to 100 days of care per benefit period. Longer stays may be covered by long-term-care insurance or Medicaid.

Nursing home care is expensive.

The average cost is $108,405 a year for a private room and $94,900 for a shared room, according to the American Council on Aging, but prices vary by location.

You can use data to find a good nursing home. Nursing homes are required to collect a broad range of data on resident health, including things like weight changes and bedsores. This data and nursing home star ratings (5 stars being the best) are available at the Care Compare website of the Centers for Medicare and Medicaid Services.

One important data point is staffing. “You want to be over 4.1 hours [of nursing care] per day” for each resident, says Sam Brooks, with The National Consumer Voice for Quality Long-Term Care. But only 26% of nursing homes in the United States provide that level.

Experts also advise visiting facilities and asking plenty of questions. AARP has a list of questions to ask.

Learn more about care options and communities

Pay attention to the form of ownership.

About 70% of U.S. nursing homes are operated for profit, about 25% are nonprofit, and the rest are owned by government entities. Generally, nonprofit nursing homes have higher staffing levels. On average, nonprofits provide 4.28 hours of staff attention per resident each day, while for-profits provide 3.56 hours.

While profit status doesn’t control quality, one subcategory of for-profit ownership has raised alarms. An estimated 5% of nursing homes are owned by private equity firms, according to Weill Cornell Medicine, which says private-equity-owned nursing homes offer lower-quality long-term care.

Reforms are in the works.

The Biden administration last year launched an effort to improve nursing home care, aiming to increase transparency in ownership, create minimum staffing requirements and increase private rooms for residents.

The White House has already proposed a rule that would beef up staffing, an initiative welcomed by consumer advocates but resisted by some industry groups.

Elaine Silvestrini is senior retirement editor at Kiplinger.com. For more on this and similar money topics, visit Kiplinger.com.

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