Finding a Nursing Home Anywhere in the U.S., Its Rating and Steps to Take if You Have a Complaint


(3/19/21)- California’s attorney general has filed a lawsuit against Brookdale Senior Living, the operator of multiple nursing homes in the state, accusing it of filing false data aimed at

 improving its Medicare star rating system and its revenue.


That system, which is overseen by the Centers for Medicare and Medicaid Services (CMS), is based largely on unaudited data submitted by the nursing homes.


The lawsuit, which was brought in Superior Court in California, alleges that until April 2018, Brookdale submitted false information about how many hours Brookdale’s nursing staff worked.


Starting in 2018, CMS began using payroll data which logged nurse’s daily hours for star ratings, rather than relying on the homes’ ’reporting data. The prosecutors allege that this resulted in

Brookdale’s getting a higher rating than what it actually were entitled to get.


Prosecutors also accused Brookdale of evicting or transferring that the chain “could fill its beds with residents who will bring in more money”.


(3/12/21)- Federal officials at the Centers for Medicare and Medicaid Services lifted restrictions allowing indoor visits for all residents regardless if the resident is vaccinated in nursing homes.


In  nursing homes where less than 70% of the residents are vaccinated, and there is a heavy incidence of Covid-19 in the surrounding county, indoor visits will not be allowed.

(11/26/19)- The government’s database Nursing Home Compare added a red circle with a white hand inside by the name of nursing facilities recently cited for abuse or neglect. That mark has been affixed to 760 of the 15, 262 facilities in the database of homes to 1.4 million elderly and disabled adults, according to StarPRO, a data analysis company.

The homes that are affixed with the red circle are ones where government investigators found evidence of abuse that led to harm of a resident within the past year and/or neglect that could have potentially led to harm of a resident in each of the past 2 years.

The symbols are updated monthly and can come off if the flagged facility is without an abuse for a year.

Senator Chuck Grassley (R. Iowa) chairs the Senate Finance Committee which oversees Medicare and Medicaid.

(10/1/15)- The following is an e-mail that we received from Landon Biehl to Harold one of the editors at therubins that contains links to 2 sites that were helpful to Landon in making decisions regarding the placement of a loved one in a nursing facility. We thanks Landon for taking the time to send us the e-mail

From: Landon Biehl <>
Date: Tue, 29 Sep 2015 13:25:45 +0000 (UTC)
Subject: Following up from last week
Good Morning,

I wanted to follow up from my email last week, since I haven't heard back from you. After searching around for various care information for my grandmother, I came across your website. Placing her in a home has not been easy. I found your website to be useful in providing information about caring for our elders.

I wanted to share two resources that have been really useful in the past few weeks: provides information and statistics for families to use regarding proper placement into nursing homes. Also, helps to locate nursing care facilities in your area, and shows health scores, ratings, number or nurses on hand, reviews etc.

Would you be willing to help me make an impact, by sharing at least one of these resources with your website? I think they could really help.

I look forward to hearing from you!


(8/7/16)- The Centers for Medicare & Medicaid Services (CMS) on Wednesday released overall hospital quality star ratings on the Hospital Compare website. While CMS already posts quality data on hospitals and other kinds of healthcare providers, this is the first time it has published the overall hospital ratings, which rank institutions on a scale of one to five stars

(6/21/15)- New federal guidelines stipulate that nursing homes are graded on the percent of their dementia patients receiving antipsychotic medications. That figure becomes part of their rating on Nursing Home Compare, a tool from Medicare that helps consumers compare information about nursing homes.

(2/24/15)- As we noted in our item dated 2/15/15 below, the Centers for Medicare and Medicaid Services (CMS) has readjusted the methodology it uses to award stars on its website that is the gold standard used by most consumers in evaluating nursing homes.

As a result of this readjustment only about 50% of the 15,000 nursing homes being evaluated received 4 or 5 stars, as opposed to the approximately 80% that attained this level before the change. The number of homes receiving one star in the quality area increased from 8.5% to 13%. The website gets about 1.3 million viewers a year.

The changes that took effect were mainly aimed at two of the 3 major criteria used to rate the homes on the site. Two of the three major criteria used to rate operations at homes, namely staffing levels and quality measure statistics, had been reported by the homes themselves, and these figures were not audited by the government.

A change was made last October when the federal government required nursing homes to report their staffing levels quarterly, using an electronic system that could be verified by payroll data. An auditing system was also installed that could double check the quality statistics that the homes were reporting.

The changes led to a decline in the quality measure for 63% of the homes. The staffing levels fell by about 13% under the new system

(10/29/13)-  We at therubins received the following e-mail from Scott Richards of Carecompare. We took a look at his site and found it to be an excellent resource as Scott stated in his email. We highly  recommend

recommend this site.

Scott Richards <>




I was looking to get in touch with someone to suggest a site for your helpful web sites page. Carecompare ( is a site that specializes in matching up those that need care with those that can provide it and allows for price and service comparison. I think it would be a fantastic resource for your page and that it would go great with the great resources you already have.

Take a look at the site and let me know what you think - I look forward to hearing back from you.

 Best regards,

 Scott Richards

(4/2/13)- A new website, , includes detailed reports of hospital violations dating back to January 2011, searchable by city, state, name of the hospital and key word

(1/22/12)- Here is another recent email that we received at therubins referring to a site that may be helpful to many or the viewers of this article. The site is:
How are you doing today? I hope you are having a great day. I am contacting you because I would love to suggest as a resource for your helpful sites page. is a free resource for people looking for senior housing or senior care for a loved one or themselves. With hundreds of expert-written articles, a free care advisor service and a nationwide directory of assisted living, independent living, and Alzheimer's care communities, we help people navigate the difficult issues of senior care. We are an official Google News source for news related to senior housing and senior care.

Mackenzie Tudor

(12/14/11)- We at therubins recently received the following email:

"From: Cai Xingliang;
Subject: Nursing home pricing and rating widgets for
Date: Thu, 8 Dec 2011 08:56:45

I tried to contact you a while ago on nursing homes widget from Caregiverlist, Inc. As the content manager for Caregiverlist, I though(t) your readers might be interested in our daily nursing home prices which assist in explaining senior care options and costs. Here is a link to our Widget page where you can grab and post the nursing home costs and ratings widget. We did contact 18,000 nursing homes nationwide to secure this information and are the only resource providing actual costs of nursing homes nationwide:" target Separately, if you would like to post a guest blog post, we would welcome the post as a return favor. Let me know if you have questions.
Cai Xingliang
Content Manager
Caregiverlist, Inc."

editors note: This site was created in memory or our mom. We do not have any paid advertisements on the site. It is strictly a public-service site.

(7/11)- Users of can conduct side-by-side comparisons of more than 4,500 hospitals nationwide, track performance over time against numerous benchmarks, and download tools to improve health care quality.

(6/30/11)- The Department of Health and Human Services (HHS) has a site that enables you to compare hospitals, see what the ratings are for various departments in the hospitals and what to do if you have a complaint. The site can be located at

(11/21/09)- The latest performance data on the process-of-care and hospital patient experience measures that are publicly reported by the Centers for Medicare and Medicaid Services can be found on Users of the site can conduct side-by-side comparisons of 4,500 hospitals nationwide, track performance over time against numerous benchmarks, and download tools to improve health care quality.

(6/23/08)- About 1.5 million Americans live in nursing homes, and about 22% of the 5.3 million people 85 or older had a nursing home stay in 2006. There are an estimated 16,000 nursing homes in this country, and in an attempt to improve the quality of life within these homes the Centers for Medicare and Medicaid Services (CMS) is adding a rating system to its database so that the consumer is helped in evaluating these facilities.

The new rating system will be based on a five star system that the CMS hopes to have on its site by the end of this year. In addition to this announcement, the CMS also announced that all nursing homes would be required to have a sprinkler system in operation by 2013. Up to now, only new nursing homes or those undergoing extensive renovations were required to have sprinkler systems.

In March 2005, Medicare required all nursing homes without sprinklers to have battery operated smoke alarms in patient rooms and public areas.

The new rating system will give each nursing home from one to five stars based on government inspection results, staffing data and quality measures.

The federal and state governments are the largest third-party payers for nursing home care. Medicare spent $21 billion on nursing homes in 2007, up from $17.6 billion in 2005.

Toby S. Edelman, senior policy attorney with the Center for Medicare Advocacy, and advocacy group, said two of the three criteria that CMS plans to include "are self-reported by nursing facilities and are inaccurate."

(1/28/06)- Investigators from the Government Accountability Office have concluded in a report that state nursing home inspectors often overlook serious deficiencies, including life-threatening conditions in the nursing homes that they inspect. The investigators found pervasive understatement of "serious deficiencies that cause actual harm or immediate jeopardy to patients."

The harm includes "multiple falls resulting in broken bones and other injuries, and serious, avoidable pressure sores," according to the report. Charles E. Grassley (Rep.-IO.) and Herb Kohl (Dem.-WIS.) requested the study. The report questioned data used by the Bush administration in arguing that its policies have fostered "significant improvements" in the nation's nursing homes.

Mainly state inspectors working under contract to the federal government inspect nursing homes. Federal inspectors visit about 5% of the nation's 17,000 nursing homes each year to validate the findings of the state inspectors. In the follow up inspections, federal investigators found that in 28% of the inspection that they conducted between 2002 to 2004, the state inspectors had missed serious violations in about 28% of the inspections. This proportion had increased from the 22% found in the years 2000 to 2001

Inspectors found 47,456 fire-safety violations in 2004, an increase of 20% over the previous year. Medicaid covers about two-thirds of the nation's 1.6 million nursing home residents. Medicaid and Medicare spent more than $67 billion a year on nursing home care.

In its report, the GAO concluded:

The federal inspectors found that the state quality of inspections varied greatly state by state. From 2003 to 2005 California cited 6% of its nursing homes for serious violations. During this same period of time Connecticut found 54% of its nursing homes were cited for serious violations.

(6/28/05)- After a thorough attempt to find the citation for the following item that we wrote about in this article, we could not come up with the answer.

"A federal court in Washington has upheld the government's right to inspect, cite and sanction nursing homes that endanger their residents' health and safety. The case arose when the Centers for Medicare & Medicaid Services (CMS) terminated the Medicare and Medicaid payments for a nursing home in Florida for failure to correct violations that were found to exist in the home after several inspections. These violations were said to have jeopardized the residents' health and safety.

The home had failed to rectify the violations. The CMS then ordered the home to move all Medicare and Medicaid residents to another facility. The nursing home fought the termination of the payments and the order to move the residents in the federal court. The nursing home questioned the constitutionality of the nursing home enforcement system by the federal government. The federal court rejected the nursing home's appeal, stating that the federal government in fact had an obligation to protect the rights of residents of nursing homes that were being reimbursed for their care by Medicare and Medicaid."

If any our the viewers of this site are familiar with this case we would appreciate your forwarding any information that you may have about it on to us.

(5/26/05)- According to the results of a study done by the Long Term Care Community Coalition, a nonprofit group that has been quite critical of New York States' Department of Health for being lenient on long-term care providers, the state's health inspectors overlook many of the problems at nursing homes in the state, compared to the federal inspectors who do a much better job.

Although there were only 12 cases that were examined in the study in which federal inspectors double-checked the work of state inspectors the findings are quite intriguing. The study also compared national data and found three significant problem areas in the state. They are:

Cynthia S. Rudder, the executive director of the Coalition stated: "We feel all these findings fit together to demonstrate the failure of the Department of Health's nursing home survey and complaint system and its failure to protect nursing home residents." There are 120,000 beds in the state's nursing home system with over 600 homes operating in the state.

Federal inspectors have an average of 7.5 years of experience compared with state inspectors, who have only less than two years of experience on average. Homes that receive payments from Medicare and Medicaid are subject to being inspected by both federal and state inspectors.

(9/24/04)-A paper entitled "Barriers to Effective Enforcement" studied the penalties assessed against nursing homes for violations of federal health and safety standards in the last four years. Jerry Sandlin of the federal Centers for Medicare and Medicaid Services and David Dunbar of the Georgia Department of Human Resources wrote the paper. One of the conclusions of the paper was that: "The enforcement process has become increasingly complex, inefficient, inconsistently applied and demonstrably ineffective in ending yo-yo compliance and ridding the industry of chronically poor-performing providers."

The number of nursing homes penalized for violations of federal standards declined by 18%, to 2,146 in 2003 from 2,622 in 2001. The number of civil monetary penalties declined 12%, to 1,979 in 2003 from 2,242 in 2000. Nursing homes must meet federal standards as a condition of participating in Medicaid and Medicare, from which they received more than $64 billion last year. It is estimated that Medicaid covers more than two-thirds of nursing home patients.

State inspectors must inspect all nursing home facilities within their jurisdiction at least once a year under Medicare and Medicaid rules. Federal officials are supposed to visit at least 5% of the homes to verify the states' findings. Results of the inspections are available through the Nursing Home Compare link at . According to the inspector general of the Department of Health and Human Services consumers should use this site with caution since information was missing or inaccurate for 19% of the homes.

According to a study done by a unit of AON Corp., a Chicago based insurance-brokerage company that does business with nursing homes, and paid for by the American Health Care Association, a trade group for the nursing home industry, liability premiums for nursing homes are soaring. The study found that the liability cost per nursing home bed climbed to $2,290 in 2003 from $1,730 in 1999. In determining the liability costs for the homes the study included both malpractice insurance and litigation costs. The study surveyed the liability costs of 108 nursing homes in different states.

Because of the large increase in premiums by the nursing homes for liability insurance, many of them are asking that prospective residents forgo the right to sue the home and instead must agree to rely on arbitration to settle any claims against the homes. The rising cost for malpractice premiums has caused some homes to cut their insurance coverage, or even to drop their liability coverage to a minimum under the laws of the particular state where the home is situated.

Currently about 25% of the California nursing homes carry no liability insurance according to the California Association of Health Facilities, a trade group. In Arkansas 103 of the facilities have no liability insurance, according to a survey that was done by the Arkansas Health Care Association that was done in May 2003.

A private room in a nursing home cost $181,124 a day according to a study that was done by MetLife Inc., which was an increase of 8% from just 15 months earlier. On average Medicaid pays $118 a day for nursing home care. The cost for malpractice insurance has risen about 51% according to the study done by the AON unit. The study also determined that claims against nursing homes rose to 15.3 for each 1,000 beds in 2003, up from 13.8 in 2002.

A federal court in Washington has upheld the government's right to inspect, cite and sanction nursing homes that endanger their residents' health and safety. The case arose when the Centers for Medicare & Medicaid Services (CMS) terminated the Medicare and Medicaid payments for a nursing home in Florida for failure to correct violations that were found to exist in the home after several inspections. These violations were said to have jeopardized the residents' health and safety.

The home had failed to rectify the violations. The CMS then ordered the home to move all Medicare and Medicaid residents to another facility. The nursing home fought the termination of the payments and the order to move the residents in the federal court. The nursing home questioned the constitutionality of the nursing home enforcement system by the federal government. The federal court rejected the nursing home's appeal, stating that the federal government in fact had an obligation to protect the rights of residents of nursing homes that were being reimbursed for their care by Medicare and Medicaid.

We have come across many sites that have been set up to help the consumer become more knowledgeable about what is available at little or no cost when you are trying to get helpful information about how to deal with some of the problems of your beloved older relatives or friends. Here are some of these sites with a brief explanation as to the areas that they deal with:

The Department of Health and Human Services announced the launch of a pilot program in 6 states that will allow the consumers to compare nursing homes in respect to nine separate measures of quality. The states involved in the pilot program are: Colorado, Florida, Maryland, Ohio, Rhode Island, and the state of Washington. If the pilot program works out well it will be expanded to cover all the 50 states by the end of this year.

The nursing-home data will allow consumers to compare one facility against another and also compare the nursing homes performance with benchmarks both on a statewide and national level. Currently there are an estimated 2.9 million Americans residing in nursing homes. Please keep in mind that these databases can not replace the need to actually visit the facility so that you can see exactly how the home operates.

Initially the database will cover 6 types of information:


You will then be able to compare these numbers to other homes in the state, or even use the national numbers for comparative purposes. Also keep in mind that you may request to see the violations book that all nursing homes being reimbursed by Medicare and Medicaid must make available their violations book. The data is based on information supplied by the nursing homes themselves. Homes that knowingly submit false information can be prosecuted criminally for fraud. The government said it had adjusted the data to reflect the physical and mental condition or the residents of the home.

In our article "Selecting a Nursing Home" we discussed the importance of finding a Nursing Home that not only is well qualified, but that is also convenient for you to travel to. How do find such a place? You would also like to know if the Home is in compliance with all Medicare and Medicaid regulations. Is the Home a Medicare and Medicaid certified Home? The information available on this site has recently been expanded to include everything from the make up of the residents of the home and a comparison with other nursing home both statewide and throughout the United States. The database on this site is as extensive as anywhere on the Web. Its address is: or call the toll free number 800-Medicare (800-633-4227)

New York State Ombudsman
Information on nursing home complaints that have been resolved at a lower level than those reported to licensing can be obtained. The ombudsman tries to resolve the concerns at the lowest level, therefore these would not be shown on the Medicare nursing home surveys for example.
Martha Haase, State LTC Ombudsman, NY State Office for the Aging
(518) 474-7329
Thanks to Linda Kelly for emailing this one in to us

President George W. Bush's spokesman announced that the administration had rejected the plan discussed below to ease regulatory requirements involving nursing homes. The plan had been drawn up by the Department of Health and Human Services. According to the spokesman, Ari Fleischer "We're going to beef up and strengthen nursing home regulations.We're working to strengthen accountability". He futher stated that the plan discussed below had been "rejected out of hand" more than 2 weeks ago, because "the president believes very strongly that it's a federal responsibility to protect seniors in nursing homes." We are relieved to hear these comments and hope that actions to back these statements will follow shortly.

The U.S. House of Representatives has set up a temporary web site at, which is to be used in conjunction with the Medicare site located at when searching for information on nursing home violations.

The September 7, 2001 edition of the N.Y.Times had an article written by Robert Pear entitled "U.S. May Ease Rein on Nursing Homes". The sub-title was "Administration Would Reduce Inspections and Penalties". According to the article the present law requires that nursing homes participating in Medicare or Medicaid must be inspected once a year on the average, with no more than 15 months between inspections. The government is considering changing this to a two-year interval.." The Bush administration says that it wants to modify the enforcement process to 'rescind some sanctions that are inflexible and often considered too harsh' ".

Under the present rules, penalties are automatically assessed if the inspectors find deficiencies that cause harm or immediate danger to patients in two consecutive visits. The rules further require that the government stop payments to nursing homes that fail to comply with federal health and safety standards within 6 months of the inspection. The Bush administration would ease this penalty. The government spent $39 billion on Medicare and Medicaid payments to over 17,000 accredited nursing homes that cared for 1.6 million elderly or disabled people in 2000.

No matter how good any nursing home may be you will always observe something that you feel calls for corrective action. What are the procedures that you should follow to try and get the complaint resolved? There is no one correct procedure to follow. You must use your best judgment, but we will suggest several possible avenues for you to follow to help you resolve it.

Your first line of communication is with the Registered Nurse in charge of the resident's floor. If you are not satisfied with the response the next level to go to try and resolve the problem is the Medical Doctor who is in charge of the resident's floor. Remember that the Social Worker should be consulted also, because he/she is the resident's contact person with the administration.

If you are still not satisfied with the results contact either the Supervisor of Nursing Care at the home or the Medical Director to voice your problem. If still not satisfied with the results contact the Head of Administration at the home. At the same time advise the ombudsman at the home of your problem. This individual is your representative on behalf of the state, who is there to protect the resident's interest and well being.

If you still feel that your complaint is not being properly addressed there are governmental protections available to you. If you have a Nursing Home complaint in NYC call 1-800-425-0316; Nassau-Suffolk call 1-800-425-0323. Keep in mind that the Health Care Finance Administration is the Federal government's overseer of Nursing Homes in the United States. Their telephone number is 1-800-MEDICARE. Their web site is

Suppose you are still unsatisfied with the results. Do you take the problem to an attorney? On Friday March 26, 1999 the Wall Street Journal had an article written by Michael Moss wherein certain ethical questions were raised concerning an attorney- Better Nursing Home Advocacy Group relationship. It seems as if the law firm of Rosen & Newey in Houston, Texas paid for the toll free number that received complaints telephoned to United People Nursing Home Care.

It was also shown that the law firm answered the toll free number first and then forwarded the call to the advocacy group. The law firm also made donations to the advocacy group and in fact was their main financial support. The article also stated that the law firm also paid for the advocacy group's web site. It was also the procedure followed by a few other law firms to do the same with some other advocacy groups.

Thus the ethical question arises was the law firm violating the code of ethics in these cases? Were the donations from the law firms to the advocacy groups in fact rebates? We do not wish to judge any case where we do not have all the facts in front of us. We point these items out to you so that you may be better informed on these topics. We certainly are aware of all the good work done by many of the advocacy groups. They continue to be part of the safety network set up to protect the elderly. See our articles on Helpful Web Sites and Organizational Resources for information about assistance that is available to you.



By Allan Rubin and Harold Rubin
updated March 19, 2021.

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