Medicare and Nursing Homes
Thanks to the internet you can find reviews and ratings for nearly any service, including nursing homes. Well-informed consumers know ratings and reviews are only as useful as the information they’re based on. That’s why it’s important to understand the Medicare 5-star rating system, its strengths and weaknesses, and how user reviews can give you a clearer picture of what life in a given nursing home is really like.
How Medicare rates nursing homes
Medicare rolled out its national star-based rating system for nursing homes in 2008 to help families find quality care and avoid low-performing homes. The system uses three pieces of information to assign ratings of 1 to 5 stars: yearly health inspection reports, staffing numbers, and quality measures.
Originally, nursing homes reported their staffing and quality measure information themselves without any independent review. By 2014, a New York Times investigation revealed flaws in this approach that could “seriously mislead consumers, investors and others about conditions at the homes.”
In response, the Centers for Medicare and Medicaid Services made changes to the way ratings data is gathered. Now nursing homes send their staffing data quarterly instead of yearly, and the information is crosschecked with payroll records. Ratings now also factor in the number of residents taking antipsychotic medications, because these drugs have a history of overuse in dementia patients with agitation. The Kaiser Family Foundation says Medicare may make more improvements to the rating system in the future.
Pros and cons of the Medicare 5-star rating system
Medicare spells out its rating system’s strengths and weaknesses online. Among the plusses are comprehensive state health inspection data and federal inspection reviews, overall staffing data and staff-to-resident ratios, and a standardized national system for rankings.
On the weaker side, the quality measures and staffing data are still reported by the homes (as noted above, staffing data is verified independently). The 5-star system is intended to be a national standard, but state-by-state Medicaid program and health inspection differences make it most useful when comparing homes in the same state. For these reasons, Medicare recommends using the 5-star quality ratings “together with other sources of information.”
A more complete approach to choosing a nursing home
Health, staffing, and quality data are important, and so are insights from senior care experts, nursing home residents and their families. When your parent needs a nursing home, ask your parent’s doctors, the social worker at their hospital, a local senior care referral specialist, and friends and neighbors for their recommendations. Listen to what current residents and their families have to say, too. You can do this during visits to homes on your list and you can check reviews online.
Reviews give you information that yearly or even quarterly data updates can’t offer. You can read recent insights on life in the homes you’re considering and see if reviews are trending up, down, or staying the same. Verified reviews like those on SeniorAdvisor.com are checked for validity to give families reliable information. Nursing home administrators and owners can reply to reviews, and their responses show families how they handle compliments, complaints, and constructive criticism.
To make the best decision for your loved one, combine verified resident reviews with government ratings, recommendations from people you trust, and your own visits to the homes you’re considering. Want more information on choosing a quality nursing home? Read on.
Casey Kelly-Barton
Casey Kelly-Barton is an Austin-based freelance writer whose childhood was made awesome by her grandmothers, great-grandmother, great-aunts and -uncles, and their friends.