Placing a loved one in a nursing home is among the hardest decisions you’ll ever make. Here’s how nursing homes in all the states stack up.By Beth Dalbey, Patch National Staff  | Jan 31, 2019 5:30 pm ET | Updated Feb 1, 2019 8:38 am ET

Nursing Home Quality In America: All The States RankedPutting Mom or Dad in a nursing home is one of the most complicated and emotionally painful decisions you may ever have to make. Where you live can dramatically affect the quality of care, according to an analysis of the latest data from the Centers for Medicare & Medicaid Services.

The ranking of nursing homes in our state is based on how well they performed on the Centers for Medicare & Medicaid Services, or CMS, five-star, quality rating system. Nursing homes were rated for their performance in three areas: health inspections, staffing and quality measures.The health inspections are based on the number, scope and severity of deficiencies identified during the two most recent annual inspection surveys, as well as substantiated findings from complaint investigations.

Staffing rankings are based on two measures, solely related to the nursing staff: registered nurse hours per resident per day and total staffing hours (registered nurse and licensed practical nurse) per resident per day. (Other types of nursing home staff, such as clerical or housekeeping staff, are not included in this rating calculation).Quality rankings are based on the performance of 16 quality measures: seven for short-term stay residents and nine for long-term stay residents.

National studies show that 75 percent of older adults prefer to age in their own homes with the assistance of family, friends or professional caregivers. But there may come a time when aging relatives need more care, and that’s where nursing homes come in. There are about 15,600 nursing homes in the United States that together have 1.7 million beds and 1.4 million patients.Here’s how the states’ nursing homes ranked on the five-star quality rating system:

1. Hawaii – 3.932. Washington, D.C. – 3.89
3. Florida – 3.75
4. New Jersey – 3.75
5. Colorado – 3.74
6. Delaware – 3.73
7. Connecticut – 3.73
8. Minnesota – 3.72
9. North Dakota – 3.71
10. Idaho – 3.71
11. Washington – 3.67
12. Rhode Island – 3.64
13. Michigan – 3.63
14. California – 3.63
15. Maine – 3.63
16. Utah – 3.62
17. New Hampshire – 3.59
18. Vermont – 3.58
19. Wisconsin – 3.58
20. Arizona – 3.56
21. Iowa – 3.55
22. Alabama – 3.52
23. Wyoming – 3.51
24. Massachusetts – 3.5
25. South Dakota – 3.48
26. Maryland – 3.47
27. Oregon – 3.46
28. Montana – 3.39
29. Kansas – 3.37
30. Nevada – 3.34
31. New York – 3.33
32. Alaska – 3.33
33. Nebraska – 3.32
34. South Carolina – 3.3
35. Pennsylvania – 3.28
36. Mississippi – 3.27
37. Tennessee – 3.27
38. Ohio – 3.25
39. Indiana – 3.21
40. Virginia – 3.2
41. Arkansas – 3.19
42. Illinois – 3.18
43. West Virginia – 3.15
44. Missouri – 3.12
45. North Carolina – 3.07
46. New Mexico – 3.07
47. Georgia – 3.01

48. Kentucky – 2.9849. Louisiana – 2.8
50. Oklahoma – 2.76
51. Texas – 2.68

Of those who answered the Care.com survey, 71 percent said they were satisfied with the care their loved one is receiving in a nursing home, 18 percent said they were dissatisfied and 11 percent said they were neither satisfied nor dissatisfied.

One of the primary advantages to placing a family member in a nursing home is that they have access to skilled care around-the-clock, but that doesn’t mean they are continuously monitored. On average, the report found, each patient receives about four hours of personalized care per day.In addition to a higher level of medical attention at skilled care facilities versus assisted living facilities or in-home care, benefits of 24-hour care include meal services and assistance with strenuous activities.

More than half of those surveyed said they would provide full-time care to an aging relative if possible, but another 25.5 percent were unsure. Respondents were also surveyed concerned the most common requests made during a relative’s nursing home stay. Topping the list was requesting special food items at just over 20 percent, followed by extra attention at 19 percent and environmental accommodations (e.g., room temperature) at 17 percent. And 42 percent of respondents said they asked for some type of special accommodation to make their loved one’s stay more pleasant.

Nursing home patients’ well-being also is affected by how often their loved ones visit. The survey also revealed some interesting findings about how people feel about putting their loved ones in a nursing home, as well as how they’d feel if the situation were reversed.It found that respondents visited their loved ones six times a month on average, staying an average of one hour and 27 minutes per visit. Well over half of the respondents (55 percent) didn’t think they visited enough, averaging only four visits a month. And the 45 percent who were satisfied they were seeing their loved ones enough visited nine times a month.

The big obstacle relatives faced was working around the demands of their jobs. About 57 percent of respondents cited work issues as the No. 1 reason for less frequent visits, and around 39 percent said the visits were too depressing. The survey respondents also gave other reasons for not visiting more often, including 38 percent who cited other family obligations and 34 percent who said finances or the expense of travel was a deterrent. Only 8 percent said the distance to the nursing home kept them away.A majority of the survey respondents — 77 percent — said they felt guilty about not visiting more often. Of those, 14 percent felt extremely guilty, 21 percent felt moderately guilty, 19 percent felt somewhat guilty, 24 percent slightly guilty and 23 percent had a clear conscience about the frequency of their visits.

Feelings of guilt over the frequency of visits and placing a loved one in a nursing home in the first place aren’t unusual, the authors of the report wrote. Experts suggest that talking to others who have been faced with the same decisions may help reduce guilty feelings,.When the tables were turned, 49 percent said they would be not at all satisfied if they were placed in a nursing home for care, 25 percent said they would be slightly satisfied, 6 percent said they would be moderately satisfied and 2 percent said they would be extremely satisfied.

But among those who made the decision to place loved one in a nursing home, nearly three-fourths of them said it was a difficult decision. To make it easier, experts say it’s important to talk parents about care options as they age before a crisis erupts. That’s a difficult conversation to have, and research shows that most adults would rather have “the sex talk” with their kids than discuss senior care with their parents.Of those who made the decision to place a relative in a nursing home without that another family member’s input, 63 percent said they would make the same decision again if another relative needed assisted care. But almost 18 percent said they wouldn’t send another aging relative to a nursing home, and 19 percent said they weren’t sure if they would make the decision alone again.

The numbers changed slightly when another family member was involved in the decision. Of this group, 44 percent would send another ageing relative to a nursing home and 47 percent said they were uncertain how they would handle it.

https://patch.com/us/across-america/nursing-home-quality-america-all-states-ranked