Choosing a Nursing Home can be Overwhelming

At 79, Doris Hass is trying to care for her ailing husband and watch over her own health, too.

Ever since Willard was diagnosed five years ago with the neurological disorder, Parkinson’s, she has kept up his spirits, monitored medication, dressed him in the mornings and cooked his favorite meals–all the while keeping an eye on him.

Willard often takes off through the front door bound for church, although he has long forgotten which way to go.

Then Doris fell, broke a hip, and found herself to be an example of a grim statistic.

A 1999 study at the University of Pittsburgh found an increased risk of illness and death among those who care for their spouses. All were between the ages of 66 and 95.

“Sometimes you don’t always know when you need to stop and get help,” Doris says. “and then something happens.”

Suddenly Doris and Willard required round-the-clock care. A competent and caring home health service took over her tasks, allowing Doris to recuperate from the fall. But when monthly bills topped $8,000, Doris knew she needed advice and called her daughter. While she has been able to continue in-home care, a nursing home looms in the future.

“I’ve been fortunate to have had the same wonderful people around because Willard’s hallucinations are so difficult, but I’ve had to accept that it’s a downhill situation,” she says.


Choosing a nursing home for an aging parent is a wrenching experience. Usually a crisis in the health of a parent means that family roles reverse. The child must choose where the parent should live. To complicate the decision, of the 17,000 nursing homes in this country, many are ailing.

Vencor, Sun Healthcare Groups and Mariner Post-Acute Network, some of the largest chains in the nursing home business declared Chapter 11 bankruptcy in 1999 and January, 2000. These companies own hundreds of nursing homes in nearly every state, involving thousands of residents. Altogether, about 1.5 million Americans live in nursing homes.

Nearly a third of the nursing home revenue in their $87 billion-a-year industry comes from the Federal Government, mostly through Medicare and Medicaid. When Congress passed the Balance the Budget Act of 1997 and trimmed Medicaid expenses, critics say that nursing homes had taken on considerable debt and were deeply mired in extended building projects. Many of the biggest firms saw their stock prices plummet and lost needed capital.

Their woes are compounded by a strong economy and fewer workers. Nursing home salaries are among the lowest for skilled workers. Those charged with most of the patients’ care are paid on average $7.45 an hour.


At the same time, consumer watchdog groups are clamoring for Congress to impose more accountability, some suggesting that cameras be installed in every nursing home room.

The practice of elderly law, evidenced by the membership in the National Academy of Elder Law Attorneys, increased tenfold in recent years to 3,500 members. And support groups for children of the aging have sprouted everywhere.

One result of consumer watchdog efforts is that it’s now easier to investigate how nursing homes stack up. The official Medicare site includes a page dedicated to nursing home comparisons:

Click on the web site and you’ll be asked to supply a zip code. The page will display all the nursing homes in the zip code with the results of their most recent inspection. Consider that about 40 percent of nursing homes with the most severe deficiencies are repeat offenders. This site makes it possible to weed out those facilities.

Nursing home care averages about $300 a day, which is not enough, industry representatives say, especially for very sick people. The average elderly individual who enters a home runs through his entire assets within six to nine months. At that point he’ll become a Medicaid patient, dependent on funding from the government. That’s why it’s important to understand the eligibility for Medicaid as well as Medicare. A nursing home that says “Medicaid-certified” indicates that your parent will not be removed when private funds run out. Before this happens, says Eileen Doherty, the executive director of the Colorado Gerontological Society, find legal help to protect financial assets for the remaining spouse.


Despite the dismal health of some nursing homes, there are caring and well-run facilities. Some may be long established with an excellent record. Or, they may be recently built with a top-notch staff. Either way, when you investigate a nursing home, you’re catching it at a moment in time. You may have to move your parent if the quality of care declines.

Doherty rarely recommends searching out a nursing home ahead of time. “They can turn around on a dime. Perhaps the administrator leaves, and the staff follows. So it’s not safe to make these recommendations in advance,” she says.

After checking state inspection results, visit the homes of your choice. Ask for the patient-to-staff ratio and request to be introduced to a family organization–or consider starting one. These are valuable support groups and often will help to check on your parent if you need to take an extended vacation.

For those nursing home residents who have no family or friends to look after them, one non-profit organization has taken on the challenge.

The Denver Regional Council of Government offers the Ombudsman Program, a free advocacy service for both nursing home and assisted-living residents. Volunteers visit residents among the 250 assisted-living facilities and 100 nursing homes along the Front Range.

Advocates for the elderly complain that as many as two-thirds of nursing home residents see fewer than a single family member once a year. While this may be because many of the residents have memory loss, it’s important that their health and well-being be monitored as often as possible. Even if your parents are confused, or no longer recognize family members, you remain their best advocate.


  • The Eldercare Locator at (800) 677-1116 or A free service that will give you the address and telephone number of the aging services in your county.
  • In Denver the Colorado Division of Aging is at 303-620-4147.
  • The Legal Center, 455 Sherman St., Suite 130 Denver 80203 is at It’s a service for the elderly and disabled.
  • The Department of Human Services in Colorado is at
  • Alzheimer’s Association is at
  • The Denver Regional Council of Government, known as DRCOG is at 303-480-6787.
  • To contact the Medicaid and Medicare web sites, go to:
  • If you need to find out Social Security disability income, the web site is
  • The Colorado Gerontological Society is at
  • National Council on the Aging list of benefits: