Nursing homes in US with star quality rating system

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For the first time in history, the Centers for Medicare & Medicaid Services (CMS) of US released quality ratings for each of 15,800 nursing homes that participate in Medicare or Medicaid.

Facilities are assigned star ratings from a low of one star to a high of five stars based on health inspection surveys, staffing information, and quality of care measures. The ratings are publicly available on the agency’s Nursing Home Compare Web site at

“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 new rating system also received high marks from Sen. Herb Kohl (D-WI), 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.

“Transparency is key when it comes to nursing home quality,” said Sen. Kohl. “I commend Acting Administrator Weems today and, as always, appreciate the opportunity to work together to improve our nation’s nursing homes.”

Consulting with a panel of experts from academia, patient advocacy and nursing home provider groups, CMS developed the rating system based on each nursing home’s performance in three critical areas:

– Health inspection surveys. Each year state and federal surveyors conduct about 15,800 on-site, comprehensive assessments of each nursing home’s health care services and compliance with federal/state rules. These surveys are designed to help protect the health and safety of residents, including resident’s rights and general quality of life. Surveyors also conduct about 50,000 complaint investigations each year. Information from the most recent three years of survey findings were used to develop the ratings.

– Quality measures. The quality rating system uses 10 key 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 (bed sores) 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. There is strong evidence that low staffing levels can comprise the level of patient care in a nursing home and is considered an important indicator of quality. This measure reports the number of hours of nursing and other staff care per patient per day. This measure is adjusted to account for the level of illness and services required by each facility’s residents.

The Web site provides the public with a quality rating for each of the three areas listed, as well as a composite or total score. A five star designation means the facility ranks “much above average,” four star indicates “above average,” three means “about average,” two is a “below average” ranking with a one indicating that a facility ranks “much below average.” Rankings are dynamic and 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 noted. “Nursing homes can make dramatic improvements between rating periods, just as a previously highly-rated home could see its quality of care deteriorate. And nothing can substitute for visiting a nursing home.”

In this first round of quality ratings about 12 percent of the nation’s nursing homes received a full 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.

Source: Centers for Medicare & Medicaid Services, USA

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