CMS Sets Five Star Ratings for Nursing Homes

Breaking Down the Ratings

Medicare nursing home five star ratings
Are Medicare's nursing home ratings improving quality of care?. Henn Photography / Cultura / Getty Images

When you need nursing home care, you want to be sure that you are going to one that will not only give you good care but the best care. The Centers for Medicare and Medicaid Services (CMS) rates nursing homes on a five-star scale. What does that really mean and how can you use the information to your advantage?

Defining The Five-Star Rating System

CMS uses three factors to determine its rating scale.

These include data gathered through health inspections, reports on quality measures and how much staffing is available to residents at any given time. The data collected is then used to calculate a final rating score.

Health Inspections

State public health departments send teams of professionals to perform inspections on nursing homes every 12 to 15 months. To assure fair and objective assessments, these health inspections are unannounced. Additional inspections may be completed during the year to address any problems, referred to as "deficiencies", found during the regular annual visit.

Health inspections may take days to complete and cover a wide array of issues from medication management to skin care to food services to resident quality of life. Patient complaints are also reviewed during this time.

CMS uses the last three years of health inspections to decide its rating score.

Quality Measures

For residents who stay in nursing homes long term, CMS assesses quality based on eight measures.

Data is reported as the percentage of residents who meet the following.

Short-term nursing home stays are more common for people rehabilitating after a hospital stay or surgery, who are in hospice or who are placed in respite care. CMS uses three quality measures to assess resident risk:

  • Antipsychotic medication without a diagnosis of schizophrenia, Huntington’s disease or Tourette syndrome
  • Moderate to severe pain
  • New or worsened pressure sores

These measures are self-reported by the nursing homes and incorporated into the overall rating score.

Staffing

Staffing at a nursing home is obviously important. It reflects how much attention and care you will receive. Not only does CMS looks at how much nursing care you will receive but it looks at all the staff that crosses your path, including Certified Nurse Aids (CNAs), Licensed Practical Nurses (LPNs), Licensed Vocational Nurses (LVNs) and Physical Therapists (PTs).

Specifically, CMS uses the hours an RN gives to each resident each day in addition to the hours of total staffing given to each resident per day to rate a nursing home.

At a minimum, the government requires that an RN be present at least eight continuous hours a day and that an RN, LPN or LVN be on duty for the full 24 hours.

The more hours, the higher the rating. These values are adjusted based on how much care a resident is expected to need based on his medical status.

What You Need to Know

While the health inspections are based on visits, quality measures and staffing assessments are self-reported by the nursing homes. Without CMS oversight, these data may not be as reliable or as objective.

That being the case, you should never rely on a rating alone to decide what nursing home is right for you. Whenever possible, especially when you are looking for long-term placement, you should consider a visit to the facility to help make your choice. You can compare nursing home ratings at the Medicare website.

Sources:

Centers for Medicare and Medicaid Services. Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/usersguide.pdf. Published February 2015.

Centers for Medicare and Medicaid Services. Nursing Home Compare 3.0: Revisions to the Nursing Home Compare 5-Star Quality Rating System. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-12-2.html. Published February 12, 2015.

Medicare.gov. Nursing Home Compare. https://www.medicare.gov/nursinghomecompare/search.html. Accessed February 26, 2016.

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