Five-Star Rating System for Nursing Homes Arrives, for Better or for Worse

The Centers for Medicare & Medicaid Services (CMS) has unveiled a one- to five-star rating system for nursing homes to help consumers evaluate a nursing home's quality when selecting a facility. The ratings appear on the agency's Nursing Home Compare Web site.

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." The rankings, which will be updated monthly, are based on a nursing home's performance in three areas: quality measures, nurse staffing levels and health inspection reports.

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. The ratings indicate that nonprofit nursing homes deliver a higher quality of care than for-profit facilities, according to an analysis by USA Today.

When the rating system was announced earlier this year, Toby Edelman, senior policy attorney with the Center for Medicare Advocacy, said that two of three criteria CMS uses for the ratings -- staffing data and quality measures -- are "self-reported by nursing facilities and are inaccurate." Edelman said, "Relying on nursing homes to describe accurately how well they are doing . . . just doesn't make sense."

The National Citizens' Coalition for Nursing Home Reform issued a statement saying it commends CMS for providing a new tool for long-term care consumers but urging consumers to "not oversimplify nursing home selection."

"In reviewing the Five-Star rating for a particular nursing home, consumers should compare the rating with their own experience during a personal visit to the home," the Coalition warned. "For example, staffing data that is used for the rating system is based on the two weeks prior to the nursing home's annual regulatory survey, an insufficient period of time to represent the usual staffing pattern of the home. Consumers should visit the home and review staffing data that is required to be posted for every shift, every day."

For its part, the nursing home industry is not pleased with the rating system. In an opinion piece in USA Today. Bruce Yarwood, president of the American Health Care Association, a long-term care industry trade group, called the new rating scheme "a complex and inaccurate system that fails to provide the consumer with an appropriate tool to measure quality of care in our nation's nursing homes."

View a CMS press release on the new rating system from 2008.