Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

Written by NHAbuseGuide on June 29, 2015

Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

Medicare and Medicaid payments cover 52 percent of the costs of those staying in nursing home facilities throughout the United States. As a result, more than 15,500 facilities who accept elderly patients who are covered under these programs are required to maintain certain standards in order to continue accepting Medicare and Medicaid patients. These standards, which are provided by the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), were created in response to concerns about the adequacy of and quality of care in these facilities.

In an effort to provide insight into the nursing homes available through these programs, the Centers for Medicare and Medicaid Services provide a Five-Star Quality Rating System through the Nursing Home Compare website to assist family members with choosing a facility for elderly loved ones. Based on the results of this website, an issue brief was released to provide state and national-level analysis of the ratings and policies concerning care in Medicare and Medicaid-approved nursing homes. The following are some of the key findings of this analysis.

Understanding the Ratings

In order to understand the analysis of the CMS rating system, it is important to understand that the ratings are based on state inspections, as well as state-required licensing.

The ratings are broken down into three major ratings:

  • Staffing – This measure is used to report the number of nurses in relation to the number of residents in the nursing home facility. Included in the rating are patient care needs, RN hours to resident days, and the total number of nurse hours per resident days. In order for a nursing home to receive five stars in this category, the facility must meet the five star level for both total nurses and RNs. Any facilities with a one star rating will have less than three hours of total nursing staff and less than 16 minutes of RN time per day and resident.
  • Quality – Quality ratings consider the overall health and function status of all patients receiving care in the facility. Also included in the quality ratings are how many patients are suffering from moderate to severe pain levels, major injuries due to falls and the occurrence of new or worsening bedsores. These scores, along with eight other measures are used to determine the overall quality score of each nursing home facility.
  • Overall – The overall star ratings for nursing homes include the above measures along with scores from state health inspections. There are a number of algorithms that go into determining a facility’s overall score to ensure it doesn’t receive a higher score based on one specific measure. These measures and algorithms are applied using a curved scale that includes:
    • The top 10 percent of facilities in a state receiving a 5-star rating
    • The lowest 20 percent receiving a 1-star rating
    • The remaining facilities receiving two, three or four star ratings

Important Findings

There are a number of findings based on this analysis, but those that receive major consideration include:

  • 39 percent of nursing home residents are in facilities receiving 1 and 2-star ratings
  • 41 percent of residents are in facilities receiving 4 to 5-star ratings
  • Nonprofit nursing homes and those with lower numbers of beds generally receive higher ratings than larger and for-profit facilities
  • State health inspection scores tend to be lower than self-reported measures
  • Facilities in states with higher numbers of low-income seniors generally have nursing homes with lower star ratings

Understanding the CMS ratings of nursing homes is an important consideration when choosing a facility for an elderly loved one. As the state and national rankings continue to evolve, policymakers hope that the changes will result in higher quality of care.

Sources:

https://www.medicare.gov/nursinghomecompare/search.html

http://kff.org/medicare/issue-brief/reading-the-stars-nursing-home-quality-star-ratings-nationally-and-by-state/

http://kff.org/report-section/reading-the-stars-nursing-home-quality-star-ratings-nationally-and-by-state-issue-brief/

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