The Centers for Medicare and Medicaid Services (CMS) created the five-star quality rating system as a resource to help individuals, families, and caregivers find out more information about nursing homes (skilled nursing facilities) that participate in Medicare or Medicaid. The rating system helps to provide an easy-to-understand summary of three aspects of nursing home quality: health inspection results, staffing data, and quality measure data. Using this information, along with further research, can help individuals and families differentiate between high-performing and low-performing nursing homes.
Each nursing home has unannounced, comprehensive inspections once a year, generally. The inspectors follow a specific process to determine the extent to which a facility has met Medicare and Medicaid minimum quality requirements. There is an overall rating out of five stars for each nursing home, and separate, individual ratings for each area:
The health inspection rating contains the two most recent health inspections and inspections relating to complaints within the last three years. CMS bases the rating on the number, scope, and severity of deficiencies identified during recent inspections, in addition to considering substantiated findings from complaint investigations.
The staffing rating has information about the number of hours of care provided on average to each resident, each day by nursing staff. There are two components to this rating: 1) registered nurse (RN) hours per resident day, and 2) total staffing hours (RN + Licensed Practical Nurse (LPN) + nurse aide hours). The rating takes into account the different levels of need residents in each nursing home need; if a nursing home has residents with very severe needs, it would be expected to have a higher number of nursing staff than a nursing home where resident needs were not as high.
Nursing Home Quality Measures
This measure offers information about how well nursing homes are caring for their residents' physical and clinical needs. The rating is based on performance on 11 (8 long-stay and 3 short-stay residents) of the 18 quality measures that CMS posts on the Nursing Home Compare website. Examples of such measures include percentage of residents that experience one or more falls, percentage of residents with a urinary tract infection, and percentage of residents whose ability to move independently worsened, among many other measures. However, these quality measures are reported by the nursing home, not CMS, so they should be interpreted with caution.
The overall star rating is based on the three individual star rating dimensions discussed above. The health inspection has the biggest impact on the overall rating, and is adjusted up or down depending on the staffing rating and quality measures. Each dimension of the rating is also compared to the average rating in each state and the average in the country.
While CMS does their best to make sure nursing facilities are meeting their standards, more research should be done to determine the best facility for your loved one. This rating system cannot address all of the important considerations you must take into account when choosing a nursing home, such as distance from family and friends that visit, or specialized care for dementia or rehabilitation. A visit to the nursing home is also one of the best ways a family can get a feeling for the quality of the facility, and this rating system can help provide questions to ask during a visit.
Regardless of a nursing home's rating, sometimes injury and wrongful death does happen. If you or a loved one have been abused, neglected, or hurt in a nursing facility, don't hesitate to reach out to Daniel Pleasant Holoman LLP. We focus on medical cases and have extensive experience in nursing home cases in particular, and we may be able to assist you or your loved one get the help you need to recover from devastating injuries. We can be contacted through our website or by phone at (910) 679-4360.