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  • Publication # 14-RA004

Very few nursing homes are accredited by the Commission on Accreditation of Rehabilitation Facilities

Elderly Health/Long-Term Care

In 2010, there were 246 nursing homes accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), representing just 2 percent of all homes. CARF also accredits medical rehabilitation programs and dementia and stroke care specialty programs. A new study found that CARF-accredited homes had better care quality than non-accredited homes for short-stay quality measures, such as percent of residents who got flu shots during flu season. 

The 246 CARF-accredited nursing homes were compared with 15,393 non-accredited homes on the 7 quality indicators used by CARF. The total nursing homes compared represents 97 percent of all nursing homes in the United States in 2010. In addition to flu vaccination, the care quality indicators included the percent of short-stay residents given the pneumonia vaccine, residents who have delirium, those who have moderate to severe pain, and those who have pressure sores. The other 2 measures were a 5-star quality measure score and 5-star health inspection score. These last 2 criteria provide an overall assessment of nursing home quality. CARF-accredited nursing homes differed significantly from the other homes when it came to national averages for 6 of the 7 quality measures. 

The only exception was no difference in the percent of short-stay residents who had delirium. There were also differences in various internal, external, and organizational factors in CARF-accredited nursing homes compared to non-accredited ones. For example, the number of nurse aide staff was significantly higher in CARF-accredited homes. These homes were also less likely to be for profit (4 vs. 63 percent) and to admit Medicaid patients (21 vs. 63 percent). 

The researchers point out that lack of financial resources prevents many nursing homes from seeking voluntary CARF accreditation. They recommend that financial incentives be provided to accredited facilities, similar to what is being done in Ontario, Canada. The study was supported in part by AHRQ (HS13983). 

See "Impact of voluntary accreditation on short-stay rehabilitative measures in U.S. nursing homes," by Laura M. Wagner, Ph.D., R.N., Shawna M. McDonald, M.Sc., and Nicholas G. Castle, Ph.D., in Rehabilitation Nursing 38, pp. 167-177, 2013.


Page last reviewed February 2014
Internet Citation: Very few nursing homes are accredited by the Commission on Accreditation of Rehabilitation Facilities: Elderly Health/Long-Term Care. February 2014. Agency for Healthcare Research and Quality, Rockville, MD.


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