The Medicare system turns 45 years old this year. The Centers for Medicare & Medicaid Services (CMS) began rating the nation's 15,000+ nursing homes in December 2008. The goal was to create a standard for the evaluation of Nursing Homes. A 5-Star Rating system was developed to simplify, organize and compare nursing care providers.
"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:
Federal and State governments regulate any nursing care community that accepts Medicare and/or Medicaid. Communities are given an annual survey by the state, on average, every 12 - 15 months. State surveyors also investigate complaints from staff, residents or families. The surveyors review and evaluate the community based on over 180 items. These items include a wide range of standards from adherence to residents' rights to protecting residents from physical and mental abuse, to food preparation and storage. The health inspection portion of the rating system is based on the last three years of surveys, including both the annual and complaint surveys. The most recent year's surveys are weighted more heavily than the previous two years.
Staffing is often considered the key criteria for evaluating quality of care. If a care community is understaffed, residents do not receive quality care. The staffing rating has information about the number of hours of care on average that is provided to each resident each day by nursing staff. This is broken down in to an overall average, in addition to the type of caregiver (Registered Nurse, Licensed Practical Nurse, Licensed Vocational Nurse, and Certified Nurse Aide). This rating system factors in the differences in needs of residents and their medical conditions. A nursing home with more complex illnesses would be expected to have higher staffing than those will less serious conditions.
In this area of the rating, CMS looks at 10 different measures for nursing care community residents. These measures are both physical and clinical indicators of how well a resident is being cared for by the community. Some examples include looking to see if there has been decrease in residents' mobility or an increase in residents' pain. It also looks at the prevalence of pressure sores among residents.
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.
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