California Nursing Home Advocates Welcome Rating, Reforms
Three days ago the federal Centers for Medicare and Medicaid Services (CMS) launched a Five-Star nursing home rating system designed to give consumers information to compare Medicare and Medicaid certified nursing homes throughout the nation. California Advocates for Nursing Home Reform (CANHR) welcomes federal efforts to improve information on CMS’s Nursing Home Compare website, but cautions consumers they should not read too much into the ratings. The ratings are most useful for helping consumers quickly identify poor quality facilities they should avoid.
High ratings in this system are no guarantee of quality care. It is as important as ever for consumers to visit nursing homes under consideration and make a personal assessment about the quality of care. CANHR’s fact sheets on choosing a nursing home and nursing home evaluation checklist give helpful suggestions for making these visits.
Consumers who use the federal rating system should keep the following points in mind:
The ratings do not include citations issued by California to nursing homes or consider nursing home violations of California nursing home standards. Only violations of federal standards are considered. California nursing home standards often exceed federal standards. CANHR’s Nursing Home Guide includes information on violations of California standards and describes every citation issued to a California nursing home.
The ratings on staffing are unreliable. The staffing data on Nursing Home Compare is self–reported by nursing homes, is not audited, and is collected from a 2–week period just before inspections when nursing homes often pad their staffing.
The ratings don’t consider the number of complaints against a facility, a key measure of quality. With respect to complaints, the ratings only include information about violations of federal standards found during investigations. CANHR’s Nursing Home Guide reports information on the numbers of complaints for each facility.
The ratings on quality measures don’t take into account residents’ medical conditions. Nursing homes that admit residents who are post–operative, have acute conditions or who have specialized health needs may score poorly in these ratings no matter the quality of their care. The reverse is also true.
California’s nursing home inspection system is inconsistent, at best. It often fails to detect problems with quality of care, quality of life and violations of residents’ rights.
In summary, the ratings may be misleading due to inaccurate or incomplete information.
Examined from a statewide perspective, the federal ratings give yet another dismal reminder about the widespread poor care in California nursing homes. 547 of California’s 1254 Medicare and Medi–Cal certified nursing homes earned 1–star (much below average) or 2–star (below average) ratings. California Advocates for Nursing Home Reform hopes that operators of substandard nursing homes and state and federal officials respond to the ratings as a wake–up call and take long overdue actions to improve residents’ care.