For the first time in the 43-year history of Medicare, The Centers for Medicare & Medicaid Services (CMS) released a quality rating system for the nation's 15,800 nursing homes. Rolled out to consumers in December of 2008, the 5-Star Rating system was designed to make it easier to compare one nursing home to another.
"Our goal in developing this unprecedented quality rating system is to provide families a straightforward assessment of nursing home quality, with meaningful distinctions between high and low performing homes," said CMS Acting Administrator Kerry Weems . "The new information will also help consumers and families identify important questions to ask nursing homes and challenge nursing homes to improve their quality of care."
Under the 5-Star Rating system, nursing care communities are rated on three sets of information:
A February 6, 2009 AARP Bulletin article, New Five-Star Rankings: One Way to Check Out a Nursing Home best explains how the 5-Star ratings are actually calculated:
CMS uses a three-step formula to decide how many stars a nursing home should receive as an overall rating of its quality of care.
Step 1 A nursing home is first assigned a number of stars (1 through 5) according to information from health inspections of the home over three years. This number is the base rating.
Step 2 Stars are added or deducted according to the home's staff rating, which is based on the average number of hours of care per day residents receive. If the home's staff rating is 4 or 5 stars, one star is added to the base rating. If staff rating is only one star, then one star is subtracted from the base rating. If staff rating is 2 or 3 stars, the base rating remains the same.
Step 3 Stars are added or subtracted according to how well or poorly the home scores on 10 key quality measures (QM). If its QM rating is 5 stars, one star is added to the rating derived from steps 1 and 2. If the QM rating is only one star, then one star is subtracted from this rating. If the QM measure is 2, 3 or 4 stars, the rating remains the same.
As with any rating system, there are strengths and weaknesses of the review system. The strengths and limitations below are taken from the government's www.medicare.gov website.
Comprehensive: The nursing home health inspection process looks at all major aspects of care in a nursing home (about 180 different items).
Onsite Visits by Trained Inspectors: It is the only source of information that comes from a trained team of objective surveyors who visit each nursing home to check on the quality of care, inspect medical records, and talk with residents about their care.
Federal Quality Checks: Federal surveyors check on the state surveyors' work to make sure they are following the national process and that any differences between states stay within reasonable bounds.
Variation between States: There are some differences in how different states carry out the inspection process, even though the standards are the same across the country.
Medicaid Program Differences: There are also differences in state licensing requirements that affect quality, and in state Medicaid programs that pay for much of the care in nursing homes.
Overall Staffing: The quality ratings look at the overall number of staff compared to the number of residents and how many of the staff are trained nurses.
Adjusted for the Population: The ratings consider differences in how sick the nursing home residents are in each nursing home, since that will make a difference in how many staff is needed.
Self-Reported: The staffing data are self-reported by the nursing home, rather than collected and reported by an independent agency.
Snap-Shot in Time: Staffing data are reported just once a year and reflect staffing over a 2 week period of time.
In-Depth Look: The quality measures provide an important in-depth look at how well each nursing home performs on ten important aspects of care. For example, these measures show how well the nursing home helps people keep their ability to dress and eat, or how well the nursing home prevents and treats skin ulcers.
National Measures: The ten quality measures we use in the Five-Star rating are used in all nursing homes.
Self-Reported Data: The quality measures are self-reported by the nursing home, rather than collected and reported by an independent agency.
Just a Few Aspects of Care: The quality measures represent only a few of the many aspects of care that may be important to you.
The 5-Star Rating system is not meant to be a family's sole method of selecting a nursing care community. CMS does caution that this information should be used in conjunction with personal visits and research.