Revisiting How to Select a Nursing Home

To keep updated on the number of deaths in each of the nursing homes, because of the coronavirus, in New York State please go to  (4/20/20)

(5/27/20)-In her May 25 article in the NY Times entitles “Outbreaks Force a Harder Look at Nursing Homes by Paula Span writes: “A New York Times analysis as of last Thursday showed that more than 34,000 deaths-37 percent of the nation’s fatalities from Covid 19-occurred among residents and staff members in long-term care facilities. In 15 states, long-term care accounted for more than half of all Covid-19 deaths.”

(4/23/20) In their article in the April 22 edition of the New York Times “Crisis Pushes Elder Homes to the Brink” written by Matthew Goldstein, Robert Gebeloff and Jessica Silver-Greenberg, the journalists point out several of the items we discussed in this article.

Many of the nation’s nursing homes and assisted living facilities were in deep financial trouble even before the COVID-19 pandemic, and now because of it, are over the edge into bankruptcy. 

“Nursing homes for about 1.5 million people in the United States and 70 percent of the 15,400 are run for profit. While the financial picture of the industry, which also includes homes run by government agencies and nonprofits, was hardly rosy before the virus struck, it was especially precarious for many for-profit nursing homes.”…

“The industry is increasingly relying on the government for another form of support. The Department of Housing and Urban Development guarantees $20 billion in mortgages to more than 2,300 nursing homes-about 15 percent of the country’s total, up from about 5 percent a quarter century ago.”

(4/16/20)- There is an article in the April 15th edition of the New York Times entitled “Nursing Homes Deaths Top 3,800, with 45 at One Virginia Site” by Danielle Ivory, Nicholas Bogel-Burroughs and Mitch Smith in which it is stated:

“The Times has identified more than 2,500 nursing homes and long-term care facilities across the United States with cases. More than 21,000 residents and staff members at those facilities have contracted the virus, and more than 3,800 have died.”

(4/1/20)- More than 1,000 nursing home residents in New York state have tested positive for the coronavirus and nearly 15% of the state’s recorded deaths, according to a spokesman for the New York State Department of Health.

There were 1,050 confirmed cases of the virus in licensed nursing homes at 155 distinct homes, according to the department. There are more than 600 nursing homes licensed in New York State.

About 700 of these cases are in New York City nursing homes, and this number will surely continue to grow.The state Department of Health has instructed nursing homes that they must axccept patients who have been treated and discharged for COVID-19 in hospitals.

(3/26/27)-The Centers for Medicare and Medicaid Services announced that it temporarily intends to halt routine inspections of nursing homes to focus on the most dangerous situations, as COVID-19 continues to spread in nursing homes throughout the country.

“Right now, the biggest threat to our nursing home residents is the coronavirus,” said Seema Verma, the CMS Administrator. The regular inspections will be paused for 3 weeks.

(3/6/20)- Statistics from China show that nearly 15 percent  of those 80 or older who have been infected with the Covid-19 virus die from it, while about 8 percent of those infected with the disease will die from it. This age grouping constitutes a little over half the patients in the 15,700 nursing homes in this country covered by the Centers for Medicare and Medicaid Services (CMS).

The CMS issued new guidelines that updated procedures to deal with the outbreak of the Covid-19 outbreak. Included in the new guidelines are limitation on visitors to patients in the home who come from, or have visited certain countries

Infection control procedures are updated and staff training instructions are reinforced. The Centers for Disease Control and Prevention (CDC) also issued new guidelines calling on the homes to restrict visitors who have respiratory illnesses or who are running a fever.

For updated information on the Covid-19 virus infection please go to:                  

(5/20/18)  In a recent article in the NY Times, it was highlighted that using the federal Nursing Home Compare website could not be used as the sole determinant in selecting a home for a loved one or friend. The Centers for Medicare and Medicaid Services (CMS) estimates that this tool will be used about 2.4 million times in 2018.

The ratings are updated every 12 to 15 months by on-site inspections, but 2 of the 5 categories in the rating evaluation, namely staffing and quality measures, are reported by the homes themselves.

The major shortfall in the star-rating system is that they do not take into account how the residents and their families feel about the home they are living in.

The most important item to be used in evaluating a home is the fact that you  must visit the facility, talk to the staff and residents so that you can find out first-hand how good the home is. Check out the food in the cafeteria of the home.

Nursing Home Compare will be requiring homes to submit timecards quarterly. Use Yelp and other consumer reviews to check out the facility

(9/15/17)- In the article “Families Fear for Elderly Relatives in Path of Tempest” by Melanie Evans and Ann Jean Whalen in the Wall Street Journal “One in five Florida residents is age 65 or older, according to the July 2016 Census Bureau, estimates, compared with about 15% nationwide. The nine southern counties of Florida include 1.3 million residents over 65, of whom 320,000 live alone according to the Census estimate.

Thirty Florida hospitals and nearly 400 nursing homes, assisted living and other health care facilities had announced evacuations as early as Sunday evening, according to the state’s Emergency Operations Center”.

(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

(2/15/15)- Thomas Hamilton, the director of the survey and certification group at the Centers for Medicare & Medicaid Services announced that it would be changing the way it measures nursing homes, making it more difficult for them to earn 4 or 5-star ratings.

Nursing homes are scored on a scale of one to five stars on Nursing Home Compare, the federal website that has become the gold standard for evaluating more than 15,000 nursing homes in the Medicare-Medicaid system.

In October, the federal government required nursing homes to report their staffing levels quarterly, via an electronic system that can be certified with payroll data. It also began a nationwide auditing program to check on the accuracy of a home’s quality statistic.

Eleven percent of the nursing homes rated 5-stars in 2013, the latest year this information was available.

The federal government is making it harder for nursing homes to get top grades on a public report card, in part by increasing, for the first time, scrutiny of their use of anti-psychotic drugs and raising the bar on an array of other quality measures.

(8/27/14)- Kate Thomas, in an article that appeared in the August 25 edition of the N.Y. Times, entitled “Ratings Allow Nursing Homes To Game System” points out that just because Medicare rates a nursing home “five stars” doesn’t mean you can forgo an onsite visit to a prospective nursing home yourself. We reiterate that the most important item in the selection process is your own visit to the institution.

The problem in relying on the federal rating system is that many of the criteria used to determine the rating come from the home itself. She wrote: “in 2009, when the (rating) program began, 37 percent 37% of them received four-or-five-star ratings. By 2013, nearly half of them did.”

The article goes on to state that more than 95%  of the homes on the list received one or two stars for the health inspection, which is conducted by state workers. The government does not verify the data reported by the nursing home

Medicare plans to introduce the rating system for hospitals, dialysis centers and home-health-care agencies.

Three criteria are used to determine the homes rating, two of which are reported to Medicare by the homes, those being staffing levels and quality statistics. The third criteria is the health inspection done by state inspectors.

(4/25/14)- Democratic Governor Andrew Cuomo of New York created a Medicaid Redesign Team in 2011 aimed at reining in the state’s escalating costs for Medicaid residents of nursing homes. One of the results of this effort was a plan to provide long-term care for as long as possible that is less expensive than nursing homes.

Starting June 1, everyone in a nursing home in New York State will need a contract with a managed long-term care plan. Medicaid does not pay the same daily rate for its beneficiaries as does private paying residents. Many of the non-profit nursing homes have a higher cost structure than the for-profit companies, which may result in them losing residents to the other type facilities.

To meet this challenge, many nursing homes have added home-care services, day-and-night care aides, assisted living facilities and independent middle-and- low income housing operations to their portfolios. They no longer are just “nursing home” operations.

The Hebrew Home at Riverdale has expanded its operation to include these added choices and will be changing its name to reflect this fact to the River-Spring Health.

(3/3/09)- We recently received this e-mail, and included Harold's response to it:

----- Original Message -----                       
Sent: Sunday, February 15, 2009 9:32 AM
Subject: H E L P

I found a piece of paper in an old laptop case with your e-maIL address. How fortunate for me. I am presently faced with a difficult situation. My mom lives alone in Manhattan, she is 92 and needs some assistance when going food shopping and doctors appointments. Her only income is social security. I live upstate. Any suggestions would be greatly appreciated. Thank you.

Here's Harold's response:

There are services available in NYC for older individuals who need assistance in independent activities of daily living (IADL). Have you tried contacting Dorot on West 85th St in Manhattan (212-769-2850), the Burden Center on the East Side (212- 535-5235)?. Also call the Office of Aging in NYC (212-442-3086). She may be eligible for CityMeals on Wheels program (212-687-1234). Explain the situation to them and ask for resources to help your mother. If this doesn't work, let me know and I will suggest other sites.
Harold Rubin

(2/17/09)- We recently received this email and have added it to this article along with Harold's response:

Subject: Questions about medicaid

Dear Harold,

I've recently come across your website, in my search for help for my aged parents. My mother, who is 75, is the primary care giver of my father. He is 85 and has late second stage Alzheimer's disease. They are both living on SS.

As my father's mental health has declined to the point that he has become a burden on my mother, I am desperately looking for the way to get him on Medicaid, and to get her relief by way of an Alzheimer's adult day care program or a home attendant for a few hours a day for him.

As this is all very new to us all and we don't know how to navigate all the help systems that might be involved in this, and as there is very little time left in the day for me that may be devoted to this search and actual 'leg work', I have thought of hiring someone whose specialty is precisely this: someone who would do the paperwork and send it to the right place, at the right time, in the right form and language.

I have come across one such company — (edited). I have spoken with their representative, (edited), and I've presented the case to him. He has described his services, the paperwork that this would require, and the average time-table for verdicts/results (6-8 weeks). He has also quoted his fee — $5,000.

Here are my questions:
1. Given the complexity of the 'system' (whatever that complexity is) and our total lack of experience with it, should we use such a service?
2. How reliable are these services, in your opinion?
3. Is there a 'reasonable/average' cost against which to measure the price quoted to me?
4. What should we be attentive to when shopping for such a service? What questions should we ask, other than the obvious ones?
5. Finally, are there any other companies that provide these services that you would recommend?

Whatever light your experience can shed on this for me would be very helpful and greatly appreciated at this time.
I look forward to your response.
Thank you.

Here's Harold's response:
Hi ( ):

Your dilemma is one faced by many other children in our society. There are no absolute right answers. One has to deal with ones own intrapsychic as well as interactive feelings. We faced it with our mother a number of years ago, although Alzheimer's was not an issue. We would suggest you consult the many free services available to individuals in their community. For example, in NYC, there is the Dept. of Aging staffed by experts in the area of long term care (see : for more information. I am sure there are State Offices of Aging in your parents area, which I am assuming is somewhere out on the Island. Another helpful source of info is the non profit agency FRIA (see: Is there an adult day care center in your parents area. Why not arrange a visit with them to discuss your parent's needs and see what turns out.

I am not clear what service you are getting for the $5000. Are they guaranteeing he will get on Medicaid? Are they providing geriatric social service? etc. I read the information on the web site. I do not find any statement as to Mr. (edited) credentials. His agency does offer a wide range of services and he states he knows a lot of people in the Medicare/Medicaid system which is always good and quotes a high success rate. Some of the statements sound overblown. There is no "news bulletin" after 11/06. Why not? As far as costs are concerned, Geriatric Social workers do perform this kind of service on an hourly basis. Assuming $100 per hour, this means 50 hours of work. Seems an awful long time for what?. Again, the question what are they actually doing beyond putting the application into the system. NO ONE CAN GUARANTEE RESULTS despite past performance. That is always a red flag for us.

The real answer however is how much work are you ready to put into this project yourself or is your time worth the money to have others do it for you. Only you can answer that question. We felt the time we put in going around to different sites, reading what others had to say and then using the available community resources for information was all we needed to make an optimal decision on where to place our mother. No place met all our needs, but when we prioritized them, we found the place that most likely fit. Importantly, we made sure that the site we ultimately picked knew us and knew that we would act as an advocate for our mother.

I am sorry, but we have a policy of not recommending a specific service provider because each situation is individualized and the needs are not like the dating services that exist.

Please feel free to contact us with any of your questions.

Harold Rubin


(2/07)- 3. A report issued by the Lewin Group (accessed January 26, 2007 at indicated, in a study released in November 2006,  that the use of nursing homes by the oldest seniors, aged 85 and older, has sharply declined. The use rate among this group fell from 21.1% in 1985 to 13.9% in 2004. At the same time, alternatives such as assisted-living facilities continued to develop. Approximately 1 million residents with an average age over 80 live in these facilities.

(1/3/07)- According to a report from the office of Scott M. Stringer, the Manhattan borough president, the New York State Health Department does not sufficiently monitor the evacuation plans that nursing homes are required to maintain.

The report found that the evacuation plans are not accessible to residents and family members; that there are no guidelines for how to evacuate a nursing home if transportation routes are blocked; and that there was no clear authority to decide whether a given home should be evacuated.

Mr. Stringer's office reviewed plans provided by 40 of the 180 nursing homes in the city and interviewed 28 nursing home administrators.

The evacuation plans of the homes that participated in the study varied from 2 pages to more than 200 pages. Marc E. Carey, a Health Department spokesman, said the agency had not seen Mr. Stringer's report.

(1/10/06)- The Nanking East Road Neighborhood Committee in Shanghai has taken to publicly shaming people who neglect their elderly parents, The Shanghai Daily reported. The council gives two warnings to children who fail to visit their parents at least once every two weeks. After that, their names are posted on a public bulletin board. In another part of the city, a government home for the elderly is fining children for missing weekend visits, the paper said. (AP)

(1/8/06)- Congress recently enacted changes in Medicaid coverage for nursing home care so that a nursing home resident whose home equity exceeds $500,000 would not be eligible for Medicaid coverage. A provision in the rules would allow individual states to increase this limit to $750,000

The changes enacted allow states to charge higher premiums and higher co-payments for a wide range of Medicaid benefits, including prescription drugs, doctors' services and hospital care. Medicaid recipients can be charged 10% of the cost of any item or service if their family incomes were 100% to 150% of the federal poverty level, $12,830 to $19,245 for a family of two. Recipients above that can be required to pay 20% of the cost of any item or service.

Total co-payments for all people in a family cannot exceed 5% of family income. States would not have to provide a Medicaid recipient with all the services now required by federal low, but can off a more modest package of benefits resembling commercial insurance. States will be allowed to end Medicaid coverage for people who fail to pay premiums for 60 days or more. Pharmacists can refuse to fill prescriptions and doctors and hospitals can deny services for recipients who do not make required co-payments.

(12/29/05)- With the new Medicare prescription drug coverage plan due to go into effect on January 1, 2006 many nursing homes are desperately trying to find out who will pay for the medications being taken by its residents. About two-thirds of the 1.5 million residents of nursing homes are participants dual eligible in both Medicare and Medicaid. Under the new law dual eligible beneficiaries have been assigned randomly to one of the drug plans. Finding out which plan they have been assigned to has become difficult to ascertain.

Each plan has its own formulary, unlike the previous system where most nursing home residents were covered under Medicaid. Medicaid paid for all the drugs used by residents who were eligible for this type coverage. The Bush administration has sent letters to people who were entitled to the dual coverage, announcing that Medicaid coverage of their prescription drugs would end on January 1.

The nursing homes were promised that online queries to a federal Web site or faxes containing lists of beneficiaries could be submitted to the Center for Medicare and Medicaid Services, and they would receive responses within 3 days. Now the agency said that the responses would be received back in 10 days but even this is not happening.

A federal contractor, NDCHealth, is loading information onto the Web site of the CMS, but the company said that it does not have the full data needed for the system to work as originally planned. A spokesman for the CMS said all information would be available very shortly.

In New York the dual eligible have been assigned to one of a possible 15 plans, according to the State Department of Health.

(9/26/05)- Hurricane Katrina brought into the limelight the failure of many nursing homes in the New Orleans area to properly execute the evacuation plans they had in place during the emergency. St. Rita's, the nursing home in New Orleans where the owners have been charged with the deaths of 34 of its residents, had an evacuation plan, but failed to execute that plan.

A hurricane and flood is a more unusual occurrence… an evacuation caused by a fire for example is not that unusual an event. Every nursing home that receives payments from Medicare or Medicaid must have an evacuation plan in connection with any emergency that may arise within the home. Section 483.75 of the federal manual for state operators, requires that all nursing homes have a "detailed written plan" in case of emergency.

Every nursing home covered by Medicare and Medicaid must train all employees what to do in case of emergency and also hold periodic drills to practice its procedures. Title 10, Section 415.26 of New York State's health code provides for just about the same requirements on a state basis. As we go on to state in this article, length of service at the particular home of the staff is one of the most important criteria that you should consider when comparing different nursing homes that you may be considering for a beloved family member or friend.

In 2004, 1% of the nation's slightly over17,000 nursing homes were cited for inadequate emergency preparedness. If you want to check on the deficiencies cited by inspectors of the nursing homes you can either get this information from the home itself or by going to

The National Citizens' Coalition for Nursing Home Reform has a Web site that can be quite helpful to you in evaluating a nursing home. This site has links to ombudsmen and regulatory agencies in each state. You can find this site at .

According to a survey done by MetLife Inc. the average cost of a private room in a nursing home increased by 6.1% for the period of July 2003 through June 2004 to $192 a day. The state with the highest monthly stay rate is Alaska, where it costs on average $561 per day. In New York City the average cost is $312 per day.

The average length of stay in a nursing home according to the study is 2.4 years. Figures from the U.S. Bureau of Labor Statistics showed that the Consumer Price Index (CPI), which is the most commonly used inflation figure rose by 2.7% for the period of July 2003 through August 2004.

This same study concluded that the cost of a home health-care aide remained the same as it was in 2003 at an average of $18 an hour. The MetLife Mature Market Institute, a research unit of Met Life started tracking long-term care rates on a local level several years ago.

One of the biggest complaints about nursing homes in general is that living in a home is like living in an institution. In a pilot project to try and move away from this system, 30 homes are participating in a pilot project to change the cultural atmosphere in nursing homes. The pilot project involves personalizing the living conditions in the home to the individual requirement of each resident.

Under the pilot project the resident is allowed to get up in the morning whenever he/she wants to rise. The individual can eat his/her meal whenever he/she wants to eat it. Each floor in the home has its own residential committee to deal with the problems of that particular floor. Meals are not served on trays. The individual is allowed to go to rehabilitation within his/her own time frame (within limitations). As we learn more about the pilot project we will pass the information on to our viewers.

It should be noted that presently, 5% of the older population in the United States resides in a nursing home. The probability of nursing home placement increases with age and affects 22% of the population aged 85 years old. The over 85 age group represented 1.3% of the population in 1990 and it is estimated will increase to 5.1% in 2050.

(8/14/05)- We at therubins received another request for us to recommend a nursing home. We are not begging the question when we say we can give you suggestions as to what to look for when you look for a nursing home for a beloved relative or friend, but only you can do the leg work to determine what is best suited for that individual.

The following is an answer that we sent a viewer in connection with this type of question:


Seeing our parents aging and beset with various conditions which seem to multiply by the day is certainly not what we expected. We are left with hard decisions. In the case of your mother, it would seem that someone should be making some attempt to treat the depression you describe. The hospital that she is in may begin this treatment. The treatment may enhance the quality of her life especially in light of the information you provided in your email i.e.. you do not mention any physical illness.

Your question about "suggesting a nursing home" is one we avoid answering because we think it involves gathering information about the home in relation to your mother's personality and temperament as well as your sense of commitment to visit her. Only you can have this information. No one can answer that one for you.

Visit sites you are interested in. Check out the information available about these sites on the web etc. It stands to reason that as a commuter to NY, you would
seem more likely to visit "mom" at a sight closer to your home, than your work, because visiting includes Saturday and Sunday, traditional days that we do not work. We doubt you would want to come back to the city on your days off.

We think the home we chose "worked" for our mother not only because of the quality of care she got there, but also because we provided her a personal source of pleasure by having almost daily contact with her: weekdays I would spend my lunch time with her and my brother would visit after work; weekends we would share time with her. This did not mean we didn't take vacations or missed days, for we also spoke to her on the phone and had standing orders to interrupt whatever we were doing during the day when she called. We also arranged for relatives and the few remaining friends she had to visit
her. We also made sure we didn't stay in her room. We took her out in the neighborhood to the various stores. It gave her a sense of a community outside the home, just as she might have in her own home.

We hope this email points you down a road to explore. Feel free to contact us for more information. We would like to hear from you as to how you finally make your decision.

Harold Rubin

(4/25/05)- As Americans are aging so are our nursing homes. The majority of the 16,800 nursing homes in this country that house 1.6 million people were built in the 1960s. The industry's occupancy rate has fallen to 85%, from nearly 100% 15 years ago, according to Joseph Angelelli, an assistant professor of health policy and administration at Pennsylvania State University.

The most frequently asked question that we get at therubins in connection with nursing homes is: "Can you suggest a nursing home to us for our loved one in the area?" There is no answer to this question since the selection of a nursing home is such an individualized decision. We are reprinting a recent answer to such a query that Harold sent so that you can see what we are talking about:

Seeing our parents aging and beset with various conditions which seem to multiply by the day is certainly not what we expected. We are left with hard decisions. In the case of your mother, it would seem that someone should be making some attempt to treat the depression you describe. The hospital that she is in may begin this treatment. The treatment may enhance the quality of her life especially in light of the information you provided in your email i.e.. you do not mention any physical illness.

Your question about "suggesting a nursing home" is one we avoid answering because we think it involves gathering information about the home in
relation to your mother's personality and temperament as well as your sense of commitment to visit her. Only you can have this information. No one can answer that one for you.

Visit sites you are interested in. Check out the information available about these sites on the web etc. It stands to reason that as a commuter to NY,
you would seem more likely to visit "mom" at a sight closer to your home, than your work, because visiting includes Saturday and Sunday, traditional days that we do not work. We doubt you would want to come back to the city on your days off.

We think the home we chose "worked" for our mother not only because of the quality of care she got there, but also because we provided her a personal source of pleasure by having almost daily contact with her i.e. weekdays I would spend my lunch time with her and my brother would visit after work; weekends we would share time with her.

This did not mean we didn't take vacations or missed days, for we also spoke to her on the phone and had standing orders to interrupt whatever we were doing during the day when she called. We also arranged for relatives and the few remaining friends she had to visit her. We also made sure we didn't stay in her room. We took her out in the neighborhood to the various stores. It gave her a sense of a community outside the home, just as she might have in her own home.

Harold Rubin

(3/13/05)- Do private pay patients pay too much because Medicaid is shortchanging nursing home operators? This is a very interesting question that is wending its way through the New York court system. The state is being sued by the operators of 58 nursing homes around Rochester, and the southern tier of the state, alleging that they are forced to charge private-pay residents exorbitant amounts to make up for inadequate Medicaid reimbursement made rate by the state to the nursing home operators.

The lawsuit was filed in state Supreme Court in Rochester, seeking to have the state recalculate rates based on current economic standards. The method for calculating the rate has not changed since 1983. This in turn has put the burden on the private-pay residents who have to be "overcharged" in order for the nursing homes to stay solvent.

Medicaid covers about 70% of nursing home residents. One of the private-pay plaintiffs in the lawsuit is a 100-year old woman by the name of Anna C. Malone of St. Ann's Home in Irondequoit, near Rochester. Whereas a Medicaid resident pays about $56,940 at that home, Anna pays about $114,610.

Sixty-two Buffalo, N.Y. area nursing homes lost a similar suit last year in that city's Supreme Court, but the plaintiffs are appealing that decision.

(1/5/03)- The nursing home industry, along with many other industrial organizations are quite upset at the proposed new guidelines issued by the Occupational Safety and Health Administration for controlling repetitive-motion injuries. These guidelines were first proposed during the Clinton administration, but Congress killed the rules shortly after he left office.

At issue are proposed guidelines to control so called musculoskeletal disorders, or MSDs-muscle, nerve and joint-related injuries. According to the latest figures from the Bureau of Labor Statistics nonfatal workplace ergonomic injury and illness rates (includes sprains, strains, carpal tunnel syndrome, tendinitis, back and other pain and soreness) are about three times as great in the personal-care industry as is the case for the private industry average.

While it was lobbying Congress to kill the guidelines set up by the Clinton administration, the Bush administration promised the labor movement that it would establish a new and better set of ergonomic and MSD rules and guidelines. Elaine Chao, Secretary of Labor has stated: "We cannot do nothing."

The proposed guidelines for the nursing home industry urge nursing homes to minimize or eliminate the manual lifting of residents, using two or even three staff members, and also utilizing a full body-sling when such usage would be appropriate. The guidelines would also have the employees trained to identify and mitigate tasks that exceed their physical capacities.

Employer groups say the guidelines are too vague and too broad. They fear that subsequent administrations will use these voluntary guidelines to justify violation citations under the Occupational Safety and Health Act's "general-duty clause". This clause requires employers to ensure safe and healthy workplaces even in the absence of specific rules.

During a session with nursing-home operators, OSHA officials discussed its recent settlement with Beverly Enterprises Inc., Ft Smith, Ark. Beverly agreed to adopt a worker-training program for lifting patients, and other rules involving the lifting of the residents by the staff members. Assistant Labor Secretary John Henshaw stated; "Our message is very clear to our compliance officers that we will not use the guidelines in any way, shape or form for any kind of enforcement."

Medicare covers the cost of about 12 % of nursing home residents, since it pays for at least a part of the cost for the first 100 days that a resident spends in a nursing home. Medicaid covers about 70% of the cost for nursing home residents, which according to the latest figures means it pays an average of $105 per day. Medicare pays an average of slightly more than $300 a day for each Medicare beneficiary in a nursing home during the period of coverage.

We have often been asked if there is any site that is available to consumers where you can compare the different nursing homes for different criteria of importance for a prospective resident. One of the best sites that we know of to get this information is the Medicare site that you can view at

HHS Secretary Tommy G. Thompson announced a new proposal to improve the quality of care for nursing home residents by allowing for trained assistants to help residents eat and drink. We think this is quite an interesting idea because of the fact that the nurse's-aides and the nurses who are on duty during the meal hours need help to ensure that all the residents are properly fed.

To show you how difficult the meal period can be on the staff, let us say that each nurse's-aide is responsible for the direct care of 10 residents. During the meal hour the nurses on duty have the job of administering medications to the residents so that they can be of very little assistance to the staff in helping to feed the residents.

Suppose, as is often the case, one or two of the nurse's-aides residents is too ill or infirm to come to the meal. Usually one staff member handles the feeding of all the residents who can not come to the dining area. If too many residents can't come to the meal, that may mean that the aide must take care of the feeding of those in the dining area and also feed the resident who is too ill or infirm to come to the dining hall. Some residents require a lot more of attention and help in eating the meal.

Under the Centers for Medicare and Medicaid Services (CMS) proposal, the trained feeding assistants would be required to complete a state-approved course in order to qualify as a trained assistant. CMS will publish the proposed rule on feeding assistants in the March 29 Federal Register, with a 60-day comment period open to all to comment on. The CMS will then review all comments and make any needed changes before issuing a final rule.

It has now been over 4 years since our mom has passed away, and we continue to visit the home where she resided for 4 1/2 years. I have become a volunteer for NY Cares and I work as a volunteer transporter one night a month at that home. Some of the residents who were there when our mom was there continue to reside at the home.

I do also get a chance on the evening when I am there to visit with the nurses and nurses-aides, guards, porters and kitchen help who I came to know so well when our mom resided there. Most of the old staff is still there, and it is a pleasure to be with them again even if it is only for a short while. Please remember that one of the keys in checking up on a nursing home is to see whether or not the staff has been there for a long period of time.

Although the floor where she resided had been converted to a sub-acute care unit, a smaller wing had been given over to the long-term residents to reside in. Incidentally we were pleased to find out that New York Cares had established a regular program over at the home, and that is quite helpful to the residents since it expands their ability to socialize.

One of the few negatives that we point out is the fact that the nurse's-aides must tend to 12 residents on the night shift as opposed to the 8 residents that they attended to when our mom was there. Otherwise most of the conditions continued to be as good as we discussed in the original article "Selecting a Nursing Home".

A report ordered by Congress and prepared by the Department of Health and Human Services concluded that more than 90% of the nation's homes have too few workers to take proper care of the residents. Instead of imposing new rules regarding staffing the administration hopes that by publishing the data, "nurse staffing levels may simply increase due to the market demand created by an informed public." The report concluded that it would take $7.6 billion a year, which is an 8% increase over current spending to reach adequate staffing levels. The report and the administration's recommendations will be presented to Congress shortly.

The report stated that a resident needs an average of 4.1 hours of care each day. The nurse's aide should provide 2.8 hours of that care, with the other 1.3 hours coming from a registered nurse or a practical nurse. It would require the home to have one nurse's aide for every 5 to 6 residents from 7 a.m. to 11 p.m. According to Dr. John F. Schnelle, a co-author of the report, over 91 % of the nursing homes do not have this level of staffing. On average the homes would need to increase their staffing by 50% or more.

To reach the recommended levels according to the report, nursing homes would have to hire 77,000 to 137,000 registered nurses, 22,000 to 27,000 licensed practical nurses and 181,000 to 310,000 nurses' aides. Anyone familiar with nursing homes can tell you it is difficult enough right now to get competent staffing in most communities right now. But we must also look at the fact that proper staffing levels will mean that conditions will improve and the residents will certainly be better off as a result thereof. In addition simply setting numbers does not take into account the condition of the individual resident or patient. Some require much more individualized time than do others.

For an interesting interview on the subject of nursing home staffing please see our interview with Dianne Menio, Pres. National Citizens Coalition for Nursing Homes. Donna R. Lenhoff, Esq. is presently the Executive Director of the organization.To see their excellent site which deals with the staffing at nursing homes please go to

In addition to the increased expense that the homes would face, we also have to look at the expense this would mean to Medicare and Medicaid. These 2 programs pay for about 75% of the cost for the residents and patients in nursing homes today. One of the most pressing issues facing Medicare right now is the matter of lack of prescription drug coverage for Medicare beneficiaries. It is estimated that it would cost about $1.4 trillion over a 10-year period of time to cover the cost of an adequate prescription drug coverage plan for Medicare beneficiaries.

An article appeared in the June 22, 2001 edition of the Wall Street Journal, which told, of the efforts by Dr. David Morris to cut back on the number of medications being taken by his patients at the Riverdale unit of the Hebrew Home for the Aged. The doctor felt that many elderly people were being overmedicated unnecessarily. We do not have enough knowledge on this issue to give an informed viewpoint but one of the areas that needs improvement in nursing homes in general is the adequacy of their medical treatment. Many qualified doctors do not want to work in the "depressing atmosphere" that exists in a nursing home. If you do have a relative or loved one in a nursing home, you should take an active involved approach in dealing with the medical treatment being received by the resident.

Recently we have learned about the attempt by some nursing homes to cut back, if not even eliminate outside members of the medical profession from being able to come into the home to check up on their "healthy" patients. In both our articles on nursing homes we failed to mention the fact that you should check with the administration of the home to see whether or not your loved one's doctor or other medical professional could make a professional call to visit a "healthy" resident.

The resident's family physician may know the resident's medical condition better than a member of the medical staff of the home may know it. We are not questioning the competency of the medical staff at the nursing home, but we feel that you should make sure that the family physician or other medical professional will be allowed to make periodic visits to check up on the condition of a "healthy" resident.

Periodically we like to go back to visit the nursing home where our mom resided for 4 1/2 years. We like to do this for several reasons. The main reason is to visit with the many members of the staff who we admired and respected so much, and who we became proud to call friends. It also gives us a chance to see some of the changes that occur in a home as time elapses. We are proud to say that some of the finest people we have met in our lifetimes came as a result of our mom's stay in the nursing home.

First of all we will reiterate that visiting a nursing home can be a tough, depressing place to visit. When you choose a home you may wonder whether or not it was the "best place" you could have chosen for your loved one. We believe that our article "How To Select a Nursing Home" will give you many helpful hints on this subject. A visit to a nursing home may affect your perspective and values on life.

Most of what we wrote about in the article is still true today. Before selecting a home you should be prepared to visit the site and see for yourself the future home of a beloved friend or relative. We are not talking about the visit that you take when the administrative individual takes you on the "guided tour".

Please take the time to visit the facility on your own time. Visit the cafeteria or coffee shop. Taste the food that will be served to the residents. Speak to some visitors and some of the staff people and ask them what they like and dislike about the home. Go into the common social areas and see for yourself what is going on at various times of the day. Reading the material given to you by the administration only gives you a superficial knowledge about the establishment. Believe it or not, you can ask the local shopkeepers in the area what they think of the facility and its staff.

When we went back to visit we found that most of the staff was still working in the same facility. They might have been moved to different floors, but the old-timers were still there. We believe that one of the most critical items in evaluating a home is to determine how long the staff has been there. If you find that the staff has been there for a long period of time it usually means that they are happy with the place that they work in. If they are happy it certainly means that the working conditions are good. You can observe how clean the establishment is kept. Again we reiterate that all homes will have a certain amount of bad aromas, but is that the exception or the rule?

Most nursing homes today are expanding more into sub-acute care and trying to cut back somewhat on long term care. The Medicare-Medicaid payment system is realistically forcing them into this changeover. Find out by asking the administration if they are proposing any cutbacks in this area.

The ratio of residents to nurses-aides and nurses is climbing in most homes. Cost cutting measures are constantly being undertaken by all nursing facilities. Once again we reiterate that you must ask about these ratios and about any possible changes that may be done within the next few years.

Visit the various therapy areas that the home provides and ask about the religious facilities that may or may not be available. Check on the elevators and the waiting times for an elevator to reach you. Are the elevators manned by operators or are they automatic elevators? Are transporters available to take the residents to the different events or therapy sessions?

Even though 4 years have now elapsed since our mom passed away the criteria we set up in the article on selecting a nursing home are still operative today.

The Administration on Aging has an excellent database to help the consumer in his/her search for a nursing home for a friend or relative. To find - Consumer Information about nursing homes go to:  There are approximately 17,000 nursing homes in the United States caring for over 1.5 million older adults. This well-researched Administration on Aging web page provides information for the consumer including facility directories, statistics and research articles that are accessible on-line.

Please also see our article " Additional Information to Selecting a Nursing Home".


By Allan Rubin and Harold Rubin
updated April 23, 2020

to e-mail: or                      

Return to Home