Best and Worst Cities for Nursing Homes in the US

Two terms not mentioned in the article are elder and guardianship abuse. The prevalence of these factors can and should be huge in determining both where to retire and, if it comes to it, a nursing home for one's own parents.

Specifically abuses of elder guardianship, in which scummy lawyers work closely with nursing homes and local magistrates to usurp guardianship of elders from next-of-kin and then collectively drain the bank accounts of their elderly wards for 'services' rendered. Which sounds like a dystopian, Kafkaesque nightmare, but happens in a number of states.[1][2][3]

[1]: https://kbzk.com/cnn-regional/2018/11/05/four-plead-guilty-i...

[2]: https://www.ozarksfirst.com/news/ozarks-lawyer-testifies-in-...

[3]: http://www.providencejournal.com/news/20180831/elder-abuse-i...

I knew some nurses who worked in nursing homes. If you want a good nursing home, try to get the insider info on how many nurses work per shit, how many patients are there, and how many of these patients need nurses hourly for taking readings, giving pills, etc.

Nurses are overworked in these places, and the owners of nursing homes make money only by hiring not enough nurses. I know of a nurse, who used to not take readings, but filled them out based on yesterday readings. This, because she had so much work to do on her own.

This is not great data science. I appreciate their ranked lists and bar graphs but you see the limitations of their very basic approach when you see ND, SD, and WY are high up on the best state rankings. It's easy to infer this is because those are very small states, they have a much smaller sample size than NY or CA. And yet they present data in ranked lists or bar graphs, neither of which convey the sample size of these vastly different states and cities to the audience.

I will never go to a nursing home. I'd rather die. I have seen the inside of those places and I can assure everyone, regardless of how nice they look and whatever amenities it has, it is a horrible place to spend the last years of your life. My Dad died at home and that's the way you do it.

This dataset from CMS is probably better: https://www.medicare.gov/nursinghomecompare

I would be skeptical of family reviews as a reliable indicator. Nursing homes are almost always miserable places.

I think affluence of the local population and job competition also affect the rankings. The places with the worst-rated homes generally have larger populations of less affluent (i.e. on Medicaid or will be soon) patients, and there are also a lot of other job options for people aside from working in that sort of a facility (not the most pleasant job to be sure). The ones with the best rankings seem to be in areas where there is a more affluent population (nursing care ain't cheap) and/or jobs in a nursing care facility are more attractive compared to other local options (resulting in a higher quality workforce). A rough correlation, YMMV.

But that last bit about lack of other attractive job options contributing to a higher quality workforce was something that I was told by someone looking for nursing/assisted living care options, and in my experience (aging parents and aging parents of friends) it is actually true. I can also confirm from personal experience that New Mexico has absolutely horrible nursing/elder care.

Lastly, re: I think I'd rather kill myself than ever go live in a nursing home? You and me both. I've seen enough that I'd rather take myself out at a time/place of my choosing rather than go into nursing care. I don't think most people give it a thought though, much less have seen it firsthand.

Sometimes patients don’t have an option but to go to such a facility, at least on a short term basis. Hospitals try to discharge patients as quickly as possible, which often results in patients leaving when they may be medically stable, but are functionally compromised or are in need of services, such as iv antibiotics or wound care, that may be difficult to provide at home. If they live alone, it’s even more challenging. So the nursing facility becomes the only option. Facilities traditionally have had an easy access to a constant supply of patients, along with high reimbursement. They’ve have had little incentive to improve.

Fortunately care bundles (BPCI) are starting to change this, giving hospitals a vested interest in where their patients go and what the outcome is. Facilities are going to have to improve the level of care and service they provide - or risk shutting down.

I think I'd rather kill myself than ever go live in a nursing home. I suppose the only way I'd accept is if I had late stage dementia and didn't realize where I was.