The Centers for Medicare & Medicaid Services this week released quality ratings for each of the nation's 15,800 nursing homes that participate in Medicare or Medicaid.
For the first time in history, nursing homes are assigned ratings from one to five stars based on health inspection surveys, staffing information and quality of care measures. The ratings are available on the agency's Nursing Home Compare Web site at www.medicare.gov.
"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."
The rating system received praise from Sen. Herb Kohl (D-Wis.), chairman of the Senate Special Committee on Aging.
"With this new rating system, CMS is improving the ability of consumers to readily obtain critical information which should be used in conjunction with in-person visits to a facility," he said. "Transparency is key when it comes to nursing home quality."
CMS developed the rating system based on each nursing home's performance in three areas:
-
Health inspection surveys: Each year state and federal surveyors conduct about 15,800 on-site, comprehensive assessments of each nursing home's healthcare services and compliance with federal/state rules. Surveyors also conduct about 50,000 complaint investigations each year. Information from the last three years of survey findings were used to develop the ratings.
-
Quality measures: The quality rating system uses 10 quality measures out of the 19 that can be found on the Nursing Home Compare Web site. Areas examined include the percent of at-risk residents who have pressure ulcers after their first 90 days in the nursing home, the number of residents whose mobility worsened after admission, and whether residents received the proper medical care.
-
Staffing information: This measure reports the number of hours of nursing and other staff care per patient per day. CMS adjusts the measure to account for the level of illness and services required by each facility's residents.
The Web site provides a quality rating for each of the three areas, as well as a composite score. A five star designation means the facility ranks "much above average," four stars indicate "above average," three stars mean "about average," two stars is a "below average" ranking and one star indicates a facility ranks "much below average." The rankings will be updated monthly.
"Because quality and conditions within a nursing home can change at any time, this system is not intended to be the only tool families use in selecting the right nursing facility for a loved one," Weems said. "Nursing homes can make dramatic improvements between rating periods, just as a previously highly-rated home could see its quality of care deteriorate."
In the first round of quality ratings, about 12 percent of the nation's nursing homes received a five-star rating, while 22 percent scored at the low end with one star. The remaining 66 percent of facilities were distributed fairly evenly among the two-, three- and four-star rankings.
"Choosing a nursing home or community-based care is one of the most difficult and sometimes confusing decisions families have to make," said Thomas Hamilton, director of the CMS Survey and Certification Group, which helped develop the new system. "The new Web site improvements also include links to information for community-based alternatives to nursing homes that may be of great interest to families."
Hamilton said the five-star quality rating system is the latest in a series of improvements to the (italics) Nursing Home Compare (end italics) Web site. In November 2007, CMS published a list of the nation's nursing homes with consistently poor performance records.
Nursing homes selected as "Special Focus Facilities," or SFFs, are provided with increased oversight, including onsite inspections that occur twice as often as better performing homes. Homes with the SFF designation are clearly marked on the Web site.
"Around 3 million Americans depend on nursing homes at some point during each year to provide life-saving care," Weems said. "Adding this new quality rating system to our Web site is a huge step toward giving our beneficiaries and their loved ones meaningful information to compare nursing homes more easily."