How to Use the CMS Five-Star Quality Rating System

Many nursing homes throughout West Virginia carry the state’s renowned hospitality and goodwill toward others. Unfortunately, this is not the case in all nursing homes. A 2010 report from the University of California, titled “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2005 Through 2010,” unleashed many unsettling statistics regarding nursing home deficiencies, such as the average of 100 to 200 falls per year at nursing homes with more than 100 beds.

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As your aging mother or father gave you a healthy and safe environment, you should put considerable research into any potential nursing homes. Even nursing homes that seem pleasant and clean during a visit may harbor well-hidden cases of neglect, abuse, or inadequate care.

Since 2008, the Centers for Medicare and Medicaid Services (CMS) has used a public reporting tool to give residents and their families an easy-to-understand ranking of local nursing homes. This program, known as the Nursing Home Compare Five-Star Quality Rating System, improves transparency between the public and nursing homes, and thus allows you to make distinctions among the high- and low-performing homes near you.

But in order to make the most out of the Five-Star Quality Rating System, it is important to know how to properly use and understand it.

How to Search For Local Nursing Homes

Through CMS and Nursing Home Compare on Medicare.gov, the Official U.S. Government Site for Medicare, locating the nursing homes near you is the easiest part of the process. On the Nursing Home Compare search page, type a zip code or city name in the primary search box to locate nursing homes within a 50-mile radius. If you have a full or partial nursing home name you want to examine, you can enter that in the second search box.

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By hitting search, the website takes you to a list of nearby nursing homes. The name of the home, its address and phone number are listed alongside star ratings for categories that include Overall Rating, Health Inspections, Staffing, and Quality Measures.

Contributing Factors to Star Ratings

A quick look at the number of stars can give you a general idea of the quality of care at the home. It can be difficult, however, to find a perfect-rated nursing home that is near you and within your budget. So, what does it mean if a nursing home has a 5-star Overall Rating but only a 3-star Health Inspection rating?

Let’s take a look at the Health Inspection category to see how CMS determines its star rating. Any nursing homes that participate in a Medicaid or Medicare program receive unannounced, annual health surveys, and CMS bases the facility rating on the number, scope and severity of health violations from the three most recent surveys. These surveys also include complaint investigations and repeat revisits.

Based on the information gathered during the health inspection, CMS rates the top 10-percent cleanest nursing homes in West Virginia with 5 stars, the middle 70-percent with a 2, 3, or 4 stars, and the bottom 20-percent with 1 star.

The Staffing category reflects the nursing home’s staffing levels based on two components: Registered nurse (RN) hours per resident day and total staffing hours (RN, licensed practical nurse, and nurse aid) per resident day. The data for this information is self-reported, though CMS does identify nursing homes with unreliable data.

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Lastly, the resident-level Quality Measure (QM) category describes the quality of care at nursing homes, which includes data from federally mandated clinical assessments of all residents in Medicare or Medicaid certified nursing homes. Based on the health inspection, staffing, and quality of care, CMS is able to accurately determine the overall rating of the nursing home.

What to Do With This Information

Due to the rigorous standards that CMS employs for its Nursing Home Compare Five-Star Quality Rating System, you can anticipate the general level of care your loved one will receive. But this is only a guideline, and the rating system cannot substitute for visiting the nursing home. Neglect and abuse can occur at any nursing home, and choosing a facility with a 5-star rating doesn’t eliminate the possibility of serious abuses.

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The information from Nursing Home Compare, on the other hand, does give you valuable insight regarding what you should be looking for and asking about when visiting a nursing home. If a nursing home has a 3-star health inspection rating, for example, ask the nursing home staff about its cleanliness standards for residents and the facility.

Avoid neglect and abuse at all costs by doing your research, and the CMS Nursing Home Compare Five-Star Quality Rating System can help.

If you have questions about a nursing home abuse or neglect case — or about the care a loved one is or is not receiving at a nursing care facility, contact the Love Law Firm today for a FREE consultation.

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