The New Medicare Quality Ratings of Nursing Homes

The Center for Medicare-Medicaid Services (CMS) rolled out its new quality nursing home five star rating system on December 18, 2008.

The five star system awards points to nursing homes based on performance in three areas:

1. Inspection Surveys
2. Staffing
3. Quality Measures

The highest rating is five star which means the facility is “much above average”.

A four star rating means that the facility is “above average”, and a three star rating means the facility is “about average”.

A two star rating means the facility is “below average”, and a one star rating means the facility is “much below average”.

According to CMS’s national data, twelve percent (12%) of the nursing homes receiving medicare or medicaid dollars score five stars. Twenty two percent (22%) receive a one star rating and the rest are evenly divided between two, three, and four stars. However, facility rankings may differ somewhat from state to state.

The new five star rating system can be found on Medicare’s Nursing Home Compare website.

As with all rating systems, the five star system is of general use and is just a place to start a search for a quality nursing home.

If you work in a nursing home, be sure to ask about your facility’s ranking.

The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.
 

Who's Watching Out for the Patients?

Nursing homes receiving Medicare or Arizona Long Term Care funds must comply with federal nursing home health and safety regulations.

Nursing homes that are unwilling or unable to provide quality care must not be allowed to retain their license to engage in business in the State of Arizona.

In Arizona, the Department of Health Services (DHS) is the enforcement agency, acting on behalf of both the federal and state governments.

DHS is responsible for ensuring that Arizona nursing homes follow state and federal regulations and provide quality care to their patients. DHS is supposed to be an advocate for nursing home patients.

Nursing homes are required to be inspected at least once every fifteen months and are to be cited for any deficiency in patient care. Inspections must occur more frequently, however, in the event a complaint is filed against a nursing home for poor care.

Poor Enforcement Equals Poor Care
When health and safety regulations are not strictly enforced, nursing homes are encouraged to neglect patient care in their pursuit of profit.

Strict Enforcement Equals Good Care
On the other hand, when nursing homes are held accountable through strict enforcement, patient care and quality of life improve.

Nursing Homes Promise to Mend Their Ways
Although cited nursing homes promise the DHS that they will correct and improve patient care, many of these same nursing homes continue to provide poor patient care.

It is up to the DHS to prevent repeat offenders from providing bad care to our most vulnerable citizens.

Failure to Strictly Enforce Regulations
All too often, however, the DHS fails to act as an advocate for quality patient care and permits nursing homes with repeat violations to continue to retain their Arizona license.

Generally, the most important health and safety regulations are those that require each nursing home have sufficient nursing staff to provide quality care to patients.

However, in Arizona, there is no minimum staffing level required. This makes the DHS inspector’s role most important and difficult. They must determine whether the facility they are inspecting has enough nurses and nurse aides while considering the medical acuity and functional level of each patient.

This is a big job and the inspectors do not uniformly take the time necessary to perform this analysis.

It is up to us to demand patient protection through strict agency enforcement of health and safety regulations.

The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.