What Does The Nursing Home Rating Mean?

Armen Hareyan's picture
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The Centers for Medicare and Medicaid Services (CMS) have recently created an online tool to help people compare Nursing Homes. This tool uses a five star rating system and ranks only nursing homes that are certified to participate in Medicare or Medicaid and which provide a level of care which is considered "skilled". The ratings are based on health inspections, staffing, and quality measures.

To be part of the Medicare and Medicaid programs, nursing homes have to meet certain requirements set by Congress. The Centers for Medicare and Medicaid Services (CMS) has entered into an agreement with state governments to do health inspections and fire safety inspections of these nursing homes and investigate complaints about nursing home care.

At all times, certified nursing homes must meet over 180 regulatory standards designed to protect nursing home residents. These standards cover a wide range of topics, from proper management of medications, protecting residents from physical or mental abuse and inadequate care, to the safe storage and preparation of food.

The health inspection team consists of trained inspectors, including at least one registered nurse. These inspections take place, on average, about once a year, but may be done more often if the nursing home is performing poorly.

Using the regulatory standards, the state inspection team looks at many aspects of life in the nursing home including the following:

* The care of residents and the processes used to give that care
* How the staff and residents interact
* The nursing home environment

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In addition, inspectors review the residents' clinical records, interview some residents and family members about their life in the nursing home, and interview caregivers and administrative staff.

Fire safety specialists evaluate whether a nursing home meets Life Safety Code (LSC) standards set by the National Fire Protection Agency (NFPA). The fire safety inspection covers a wide range of fire protection concerns, including construction, protection, and operational features designed to provide safety from fire, smoke, and panic. Nursing homes that have a waiver from the health occupancy provisions of the LSC or that have an acceptable Plan of Correction are considered “in compliance.”

When an inspection team finds that a nursing home doesn't meet a specific standard, it issues a deficiency citation. Depending on the problem, the law permits Medicare to take a variety of actions. For example, Medicare may assess a fine, deny payment to the nursing home, assign a temporary manager, or install a state monitor. When Medicare takes an enforcement action, it considers how much harm was caused or could be caused when the nursing home fails to meet a standard.

If the nursing home doesn't correct its problems, Medicare ends (terminates) its agreement with the nursing home. This means the nursing home is no longer certified to provide and be paid for care to people with Medicare and Medicaid. Those residents with Medicare or Medicaid who are living in the home at the time of the termination are moved to certified nursing homes.

States record all the information they find during an inspection in the detailed inspection report (form HCFA-2567) which, in some cases, may be well over 100 pages. When the state finds a deficiency, it records the specific reasons for the deficiency in this report. Medicare makes every attempt to ensure all the states report their findings in a consistent and timely way.

Each nursing home that provides services to people with Medicare or Medicaid is required to make the results of its last full inspection available at the nursing home for the public to review. This website only shows some of the information from the inspection report.

The inspections measure whether the nursing home meets certain "minimum" standards. If a nursing home has no deficiencies, it means that it met the minimum standards at the time of the inspection. Inspections don't identify nursing homes that give outstanding care.

While reading these reports, keep in mind that the quality of a nursing home may get much better or much worse in a short period of time. These changes can occur when a nursing home's administrator or ownership changes or when a nursing home's finances suddenly change.

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Comments

State Surveys are independent evaluations of nursing facility performance. Annual surveys are conducted by state survey agencies, usually the state's department of health, using protocols, procedures, and forms developed by the Centers for Medicare & Medicaid Services (CMS). A consumer concern about surveys is the repeated finding by the Government Accountability Office (GAO), in a series of reports issued since 1998, that surveys understate deficiencies and cite deficiencies as less serious than they actually are. The survey component of CMS's proposed ranking system provides a more positive statement about quality than justified. States are increasingly using their state enforcement systems, instead of the federal system, to sanction facilities for noncompliance with standards of care. State enforcement actions do not appear on Nursing Home Compare. The National Senior Citizens Law Center recommends that consumers use the new rating system with caution, and only as an aid while also pursuing other information and strategies. Consumers need to understand that the five-star system is a beginning, not an end. A nursing home's quality can shift from month to month, so you have to be savvy in asking the right questions. Existing residents and their family members should be asked for their opinions. Inspection data is mostly based on a once-a-year survey and may not accurately reflect the nursing home's performance today. Staffing information and quality measures are "self-reported" data by the nursing homes themselves. Self-reported data makes nursing home quality "appear" to be better than it actually is. It cannot easily be reduced to a star rating. A recent GAO study found that nursing homes over-report staffing levels compared with staffing reported on audited Medicaid cost reports. Over-reporting of nursing coverage is associated with for-profit ownership of nursing homes. Researchers recommend more careful scrutiny of staffing levels in for-profit facilties during the survey process and that improvements be made to the process of public reporting of staffing levels. CMS should provide more and better information on Nursing Home Compare, including links to the actual survey forms and information about staff turnover. Also, CMS should use payroll data to report staffing information. Anything to do with "quality indicators" is bogus. When de-regulation failed under the present administration, they wanted, among other things, the "quality indicator" process to eventually replace traditional annual surverys because it relies upon self-reported, unaudited data supplied by the facilities themselves and is without consequences for failures. It leaves you with that warm-n-fuzzy "we'll-help-them-fix-their-problems," even though 99% of their failures are failures of practices they should already be experienced in before they are granted a license. It is part of the "kid-gloves," don't be-so-hard-on-the-poor-poor-nursing-homes" from the Bush administration.
State Surveys are independent evaluations of nursing facility performance. Annual surveys are conducted by state survey agencies, usually the state's department of health, using protocols, procedures, and forms developed by the Centers for Medicare & Medicaid Services (CMS). A consumer concern about surveys is the repeated finding by the Government Accountability Office (GAO), in a series of reports issued since 1998, that surveys understate deficiencies and cite deficiencies as less serious than they actually are. The survey component of CMS's proposed ranking system provides a more positive statement about quality than justified. States are increasingly using their state enforcement systems, instead of the federal system, to sanction facilities for noncompliance with standards of care. State enforcement actions do not appear on Nursing Home Compare. The National Senior Citizens Law Center recommends that consumers use the new rating system with caution, and only as an aid while also pursuing other information and strategies. Consumers need to understand that the five-star system is a beginning, not an end. A nursing home's quality can shift from month to month, so you have to be savvy in asking the right questions. Existing residents and their family members should be asked for their opinions. Inspection data is mostly based on a once-a-year survey and may not accurately reflect the nursing home's performance today. Staffing information and quality measures are "self-reported" data by the nursing homes themselves. Self-reported data makes nursing home quality "appear" to be better than it actually is. It cannot easily be reduced to a star rating. A recent GAO study found that nursing homes over-report staffing levels compared with staffing reported on audited Medicaid cost reports. Over-reporting of nursing coverage is associated with for-profit ownership of nursing homes. Researchers recommend more careful scrutiny of staffing levels in for-profit facilties during the survey process and that improvements be made to the process of public reporting of staffing levels. CMS should provide more and better information on Nursing Home Compare, including links to the actual survey forms and information about staff turnover. Also, CMS should use payroll data to report staffing information. Anything to do with "quality indicators" is bogus. When de-regulation failed under the present administration, they wanted, among other things, the "quality indicator" process to eventually replace traditional annual surverys because it relies upon self-reported, unaudited data supplied by the facilities themselves and is without consequences for failures. But it still relies upon self-reported, unaudited data supplied by the facilities themselves. It leaves you with that warm-n-fuzzy "we'll-help-them-fix-their-problems," even though 99% of their failures are failures of practices they should already be experienced in before they are granted a license. It is part of the "kid-gloves," don't be-so-hard-on-the-poor-poor-nursing-homes" from the Bush administration. Gregory D. Pawelski