For the first time in history, the Centers for Medicare & Medicaid Services (CMS) today released quality ratings for each of the nation’s 15,800 nursing homes that participate in Medicare or Medicaid. 

Facilities are assigned star ratings from a low of one star to a high of five stars based on health inspection surveys, staffing information, and quality of care measures. The ratings are publicly available on the agency’s Nursing Home Compare Web site at www.medicare.gov.

“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.”

The new rating system also received high marks from Sen. Herb Kohl (D-WI), chairman of the Senate Special Committee on Aging.  “With this new rating system, CMS is improving the ability of consumers to readily obtain critical information which should be used in conjunction with in-person visits to a facility.

“Transparency is key when it comes to nursing home quality,” said Sen. Kohl. “I commend Acting Administrator Weems today and, as always, appreciate the opportunity to work together to improve our nation’s nursing homes.”

Consulting with a panel of experts from academia, patient advocacy and nursing home provider groups, CMS developed the rating system based on each nursing home’s performance in three critical areas:

• Health inspection surveys.   Each year state and federal surveyors conduct about 15,800 on-site, comprehensive assessments of each nursing home’s health care services and compliance with federal/state rules.   These surveys are designed to help protect the health and safety of residents, including resident’s rights and general quality of life. Surveyors also conduct about 50,000 complaint investigations each year.  Information from the most recent three years of survey findings were used to develop the ratings. 
• Quality measures. The quality rating system uses 10 key quality measures out of the 19 that can be found on the Nursing Home Compare Web site.  Areas examined include the percent of at-risk residents who have pressure ulcers (bed sores) after their first 90 days in the nursing home, the number of residents whose mobility worsened after admission, and whether residents received the proper medical care.
• Staffing information. There is strong evidence that low staffing levels can comprise the level of patient care in a nursing home and is considered an important indicator of quality.  This measure reports the number of hours of nursing and other staff care per patient per day.  This measure is adjusted to account for the level of illness and services required by each facility’s residents.

The Web site provides the public with a quality rating for each of the three areas listed, as well as a composite or total score.  A five star designation means the facility ranks “much above average,” four star indicates “above average,” three means “about average,” two is a “below average” ranking with a one indicating that a facility ranks “much below average.”  Rankings are dynamic and will be updated monthly. 

“Because quality and conditions within a nursing home can change at any time, this system is not intended to be the only tool families use in selecting the right nursing facility for a loved one,” Weems noted.  “Nursing homes can make dramatic improvements between rating periods, just as a previously highly-rated home could see its quality of care deteriorate.  And nothing can substitute for visiting a nursing home.”

In this first round of quality ratings about 12 percent of the nation’s nursing homes received a full five star rating while 22 percent scored at the low end with one star.  The remaining 66 percent of facilities were distributed fairly evenly among the two, three and four star rankings.

“Choosing a nursing home or community-based care is one of the most difficult and sometimes confusing decisions families have to make,” noted Thomas Hamilton, director of the CMS Survey and Certification Group who helped develop the new system.  “The new Web site improvements also include links to information for community-based alternatives to nursing homes that may be of great interest to families.

“Regardless of the type of support a family chooses,” he said, “It is vital that families and caregivers use the Web site as just one of many important sources of information they should consult. Families should also consult with their physician, talk to the state’s nursing home ombudsman or the state’s survey and certification office and, most importantly, visit the nursing home or community-based program for themselves.”

Today’s addition of the five-star quality rating system is just the latest in a series of improvements to the Nursing Home Compare Web site.  In November 2007, CMS took another historic step in publishing a list of the nation’s nursing homes with consistently poor performance records.  Nursing homes selected as such “Special Focus Facilities (SFF)” are provided with increased oversight, including onsite inspections that occur twice as often as better performing homes.  Homes with the SFF designation are clearly marked on the Compare Web site.

“Around three million Americans depend on nursing homes at some point during each year to provide life-saving care,” Weems said.  “Most of those individuals are enrolled in Medicaid or Medicare and we all bear a special responsibility to protect their health and welfare. Adding this new quality rating system to our Web site is a huge step toward giving our beneficiaries and their loved ones meaningful information to compare nursing homes more easily.”

CMS has also today published an updated version of its Guide to Choosing a Nursing Home which can help families through the process.  The Guide can be also be accessed at www.medicare.gov.

The five star ratings on Nursing Home Compare are the most recent information to be added to the consumer information available at www.medicare.gov.  Users can find up-to-date information about hospitals at Hospital Compare (www.hospitalcompare.hhs.gov) and dialysis clinics at Dialysis Facility Compare (www.medicare.gov/Dialysis), as well as information about Medicare health and prescription drug plans (www.medicare.gov/mppf and www.medicare.gov/mpdpf). 

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