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Americans Give Nursing Homes D+ Grade for Quality of Care
Gallup Blog

Americans Give Nursing Homes D+ Grade for Quality of Care

Editor’s Note: The research detailed below was conducted in partnership with West Health, a family of nonprofit and nonpartisan organizations focused on lowering healthcare costs to enable successful aging.

Americans give nursing homes an average D+ grade for quality of care, and few say they would be comfortable living in a nursing home if they could no longer care for themselves, according to a new survey from West Health and Gallup.

The survey, which was conducted by web July 5-24 via the nationally representative Gallup Panel, also found most U.S. adults would be reluctant to admit a relative to a nursing home. Quality of care, cost, and the potential emotional and mental toll of nursing-home living are Americans’ top concerns. Perceived safety is mentioned by a smaller, but still sizable, segment.

Nursing Homes Graded Poorly for Overall Quality of Care

More than four in 10 U.S. adults grade nursing homes negatively for overall quality of care -- 36% give them a “D” (poor) and 6% an “F” (fail). Another 33% grade nursing homes as satisfactory, a “C,” while few rate them positively with an excellent “A” (1%) or good “B” (8%) grade. These ratings average out to a D+ grade for nursing-home quality of care overall.


Discomfort in Living in Nursing Homes and Top Reasons for Concern

Seven in 10 U.S. adults say they would be very or somewhat uncomfortable with being admitted to a nursing home if they could no longer care for themselves. Nearly as many, 61%, feel the same way about the prospect of admitting a relative or family member into such a facility.

Meanwhile, about one in five Americans say they would be at least somewhat comfortable with each scenario, while about one in three are neutral.


The survey asked adults who say they would be uncomfortable living in a nursing home to indicate why, by choosing up to three reasons from a list of eight possible concerns.

  • The quality of care is by far the top reason for discomfort with living in a nursing home, with 70% choosing it.
  • Cost (49%) is also a top factor, as are concerns about the potentially negative impact an admission could have on respondents’ mental and emotional health (45%).
  • Fear of losing independence is mentioned by a third (34%), while slightly fewer, 28%, say they do not want to die in a nursing home.
  • 27% have concerns about their physical safety in a nursing home facility.

More women than men cite quality and personal safety, while men are more likely to fear losing their independence or dying there.


On Balance, Nursing Homes Considered Unsafe

Safety is an area of significant weakness for nursing homes when Americans as a whole are asked directly whether they are a “safe place for older adults in the U.S.” Just one in four (26%) think nursing homes are safe places, while 41% think they are not. About a third say they don’t know.


In addition, more than four in 10 U.S. adults (42%) say nursing homes are not very or not at all effective in keeping residents safe from avoidable harms such as infections, pressure wounds, and abuse and neglect. A similar percentage (44%) consider them at least somewhat effective.


Bottom Line

Nursing homes serve a vital role in the U.S., but Americans’ confidence in their ability to keep residents safe is low, as are opinions about the quality of care they provide. As such, Americans are largely uncomfortable with the thought of ever needing one in their later years or using one for family.

The new poll makes it clear that nursing homes have much work to do to instill more public confidence in their facilities. While it’s natural that people entering nursing homes would have reservations about the lifestyle changes inherent in moving into such a care facility, they should not have to worry about their safety or the quality of care they will receive.

Policy proposals to increase minimum staff requirements and assure adequate resources for nursing homes may help improve quality and restore confidence, but these may not be enough. Meanwhile, policymakers could also invest more resources in home- and community-based options to support the growing U.S. senior citizen population.

The latest West Health-Gallup polling on nursing homes follows the 2022 Healthcare in America Report, which found Americans giving low grades to the U.S. healthcare system across a variety of areas. This most recent poll is evidence that nursing homes are another part of the U.S. healthcare system in need of improvement.

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