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Nursing Home Star Ratings

The month of May has several designations which are significant for older adults, including Older Americans Month, Elder Law Month, and National Nursing Home Week (May 14-20th).  These “celebrations” offer the opportunity for folks to share gratitude for the availability of aging services and learn more about the benefits and function of these services.

A frequent question which arises regarding nursing homes is how to choose one. The website offers a starting point on their Nursing Home Compare page by sharing information about nursing facilities which participate in Medicare and Medicaid programs. Medicare has attempted to simplify some of the technical information about how facilities operate and the quality of their services by assigning star ratings in three areas; health inspections/fire safety, quality measures, and staffing.  A composite rating based on a combination of these individual scores is also available.

Unannounced health and fire safety inspections of all nursing homes are conducted annually by the state. These inspections cover facility policies and procedures for aspects of care including residents’ rights, quality of life, medication management, skin care, resident assessment, food service, building environment, and administration.  When a facility doesn’t meet a certain standard during an inspection, a deficiency is assigned and the facility is given the opportunity to make improvements.  The star rating accounts for the number, type, and severity of deficiencies received during the previous three annual inspections, as well as the number of additional visits required to ascertain that the necessary corrections have been made.  Also included are the results of intermittent investigations which occur as a result of complaints.  Only the investigations which lead to verification of a complaint are utilized.

Quality measures scores are calculated through a review of clinical data which is submitted to the state by each facility. Some of the areas which are evaluated include the presence of skin breakdown due to pressure; the use of physical restraints, urinary catheters, and antipsychotic medications; pain management; and the occurrence of falls.  For those residents who are admitted for a short-term stay, additional areas of evaluation include rehospitalizations, the percentage discharged to the community, and the percentage of those who demonstrate functional improvements or declines.

Scores based on staffing evaluate the total staffing hours per resident per day of nurses, physical therapists, and nursing assistants. This value is combined with the number of registered nurse hours per resident per day.  These numbers are self-reported to the state by each facility.

Specific scoring techniques and technical adjustments which are made to the scores are beyond the scope of this article, however, facilities receive a score of one to five stars in each area noted above. While the star rating system for nursing homes is valuable, families who are researching care options for a loved one should use this information in conjunction with a personal visit or visits to a facility and the experiences of current and previous residents when making their decision.

Karen Kaslow, RN