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Estate and Elder Law

America's Best Nursing Homes 2011


U.S. News & World Report recently provided rankings of America's Best Nursing Homes.  The federal Centers for Medicare and Medicaid Services (CMS) collects data on nursing homes and rates them in its Nursing Home Compare program, with over 15,000 nursing homes ranked.  CMS's information is grouped by performance in health inspections, number of nurses, and quality of care.  The agency's ratings are from one to five stars in each category, and an overall rating from one to five stars.  U.S. News & World Report's rankings are based on an analysis of CMS's data, and presents the homes within each overall one to five star rating in tiers in an easily searchable format.

Health inspection ratings are based on state survey team inspections, which occur every 12 to 15 months.  The visits include a checklist of about 180 items, including infection control and food preparation, as well as medication management, residents' rights and quality of life. Investigators also review complaints from residents and their families.  Ratings depend on how many "deficiencies" are found, how serious the deficiencies are, and how many residents were or could have been affected.  CMS wants to know how many nurses a facility employs, and calculates how much time, on average, nurses and nurse's aides spend with each resident per day.  In order to achieve five stars in this category, a facility has to provide at least 33 minutes per patient per day.  For the quality of care rating, the medical status of residents is measured in ten areas related to bedsores, pain, and other clinical indicators.

The U.S. News & World Report website lists several tips that can help in a search for a nursing home:

  • Distance.  A nursing home close by makes it easier to monitor care and visit the family member.
  • See if residents' wishes count.  For instance, a married couple might want to room together.
  • How well does the staff know the residents?  "Consistent assignment" can make a big difference.
  • Look for a variety of activities for residents, like Wii fitness sessions, games, sing-alongs, and classes.
  • Ask about staff turnover.  Good facilities provide staff with good benefits and perks to help minimize staff turnover.
  • Look for nursing homes that are moving toward "de-institutionalizing" their facilities by changing from hospital-like qualities such as rooms lined up in corridors to smaller "households" with 10 to 30 resident rooms around a communal kitchen and living room.  The Pioneer Network is a leader in advancing this trend.

For more information on the nursing home ratings, including the searchable database, please visit:

The attorneys at Oast & Hook can assist clients with their estate, financial, investment, long-term care, life care, veterans benefits, and special needs planning issues. Sandra L. Smith joined Oast & Hook in 2003.  Oast and Hook has served Southeastern Virginia and North Carolina for more than 80 years. Visit their website at for more information. Ms. Smith practices primarily in the areas of elder law, estate planning, estate and trust administration, special needs planning, asset protection planning, long-term care planning and Veterans' benefits. She is certified as an Elder Law Attorney (CELA) by The National Elder Law Foundation (NELF). In 2008, Ms. Smith was named as a Rising Star by Virginia Super Lawyers magazine. Rising Stars names the state's top up-and-coming attorneys.