Search Articles

Find Attorneys

Investigative Report Questions Five-Star Rating System for Nursing Homes

  • April 28th, 2010

How reliable are the ratings given nursing homes under the five-star rating system that the federal government recently instituted? Not very, according to an investigative report by the Massachusetts magazine Commonwealth.

In an in-depth discussion of the rating system, the report highlights numerous instances in which facilities received above-average overall ratings despite being cited for serious deficiencies in care, some of which resulted in serious injuries of residents.

Local Elder Law Attorneys in Your City

Elder Law Attorney

Firm Name
City, State

Elder Law Attorney

Firm Name
City, State

Elder Law Attorney

Firm Name
City, State

The rating system, which was launched in December 2008 by the federal Centers for Medicare and Medicaid Services (CMS), gives nursing homes a rating of between one and five stars. A five-star designation means the facility ranks "much above average" compared to other facilities in its state, while a one-star designation means that a facility ranks "much below average" in the state. The rankings, which are updated monthly, are based on a nursing home's performance in three areas: quality measures, nurse staffing levels and health inspection reports.

The problem, according to the report, is that the rating scheme uses a quota system to rank facilities. Nursing homes that rank in the top 10 percent in health inspections in each state receive five-star ratings in that rating category, while facilities in the bottom 20 percent receive one-star ratings. This "grading on a curve" approach means that homes with serious deficiencies can still score high as long as their inspection records are better than most other homes in their state, while in another state a home with few problems could nevertheless receive a mediocre or poor rating.

Adding to the confusion is that the star ratings are heavily weighted by the health inspections, which are conducted by state surveyors and, according to the report, "vary considerably in scope and depth from state to state." The report points out that Massachusetts inspectors give nursing homes relatively few deficiency citations, resulting in "grade inflation" where the top 10 percent of homes would not necessarily be as outstanding as the top facilities in another state.

Disturbed by these issues, last year the attorneys general of 30 states sent a letter to CMS asking it to suspend and revise the rating system.

Nursing home consumer advocates appear conflicted about the rating system: on the one hand, they see it as a useful tool for consumers, but on the other they concede that it includes some four- and five-star homes that have been cited for negligence that resulted in deaths or injuries of patients.

According to the Commonwealth report, Edward F. Mortimer, technical director of the Survey and Certification Group for CMS, "says the star ratings should be only the starting point in the search for a nursing home, and he urged consumers to dig deeper into the information provided on the website and to visit homes in person."

Despite problems with the ratings of individual facilities, one overall trend that has emerged from the rating system is the general superiority of non-profit nursing homes compared with for-profit homes, the report points out.

To read the Commonwealth magazine report, "Misdiagnosis," click here.


Last Modified: 04/28/2010

ADVERTISEMENT
Medicaid 101
What Medicaid Covers

In addition to nursing home care, Medicaid may cover home care and some care in an assisted living facility. Coverage in your state may depend on waivers of federal rules.

READ MORE
Medicaid’s Eligibility and Transfer Rules

To be eligible for Medicaid long-term care, recipients must have limited incomes and no more than $2,000 (in most states). Special rules apply for the home and other assets.

READ MORE
Medicaid’s Protections for Spouses

Spouses of Medicaid nursing home residents have special protections to keep them from becoming impoverished.

READ MORE
What Medicaid Covers

In addition to nursing home care, Medicaid may cover home care and some care in an assisted living facility. Coverage in your state may depend on waivers of federal rules.

READ MORE
Medicaid’s Eligibility and Transfer Rules

To be eligible for Medicaid long-term care, recipients must have limited incomes and no more than $2,000 (in most states). Special rules apply for the home and other assets.

READ MORE
Medicaid’s Protections for Spouses

Spouses of Medicaid nursing home residents have special protections to keep them from becoming impoverished.

READ MORE
Medicaid Planning Strategies

Careful planning for potentially devastating long-term care costs can help protect your estate, whether for your spouse or for your children.

READ MORE
Estate Recovery: Can Medicaid Take My House After I’m Gone?

If steps aren't taken to protect the Medicaid recipient's house from the state’s attempts to recover benefits paid, the house may need to be sold.

READ MORE
Help Qualifying and Paying for Medicaid, Or Avoiding Nursing Home Care

There are ways to handle excess income or assets and still qualify for Medicaid long-term care, and programs that deliver care at home rather than in a nursing home.

READ MORE
Are Adult Children Responsible for Their Parents’ Care?

Most states have laws on the books making adult children responsible if their parents can't afford to take care of themselves.

READ MORE
Applying for Medicaid

Applying for Medicaid is a highly technical and complex process, and bad advice can actually make it more difficult to qualify for benefits.

READ MORE
Alternatives to Medicaid

Medicare's coverage of nursing home care is quite limited. For those who can afford it and who can qualify for coverage, long-term care insurance is the best alternative to Medicaid.

READ MORE
ElderLaw 101
Estate Planning

Distinguish the key concepts in estate planning, including the will, the trust, probate, the power of attorney, and how to avoid estate taxes.

READ MORE
Grandchildren

Learn about grandparents’ visitation rights and how to avoid tax and public benefit issues when making gifts to grandchildren.

READ MORE
Guardianship/Conservatorship

Understand when and how a court appoints a guardian or conservator for an adult who becomes incapacitated, and how to avoid guardianship.

READ MORE
Health Care Decisions

We need to plan for the possibility that we will become unable to make our own medical decisions. This may take the form of a health care proxy, a medical directive, a living will, or a combination of these.

READ MORE
Estate Planning

Distinguish the key concepts in estate planning, including the will, the trust, probate, the power of attorney, and how to avoid estate taxes.

READ MORE
Grandchildren

Learn about grandparents’ visitation rights and how to avoid tax and public benefit issues when making gifts to grandchildren.

READ MORE
Guardianship/Conservatorship

Understand when and how a court appoints a guardian or conservator for an adult who becomes incapacitated, and how to avoid guardianship.

READ MORE
Health Care Decisions

We need to plan for the possibility that we will become unable to make our own medical decisions. This may take the form of a health care proxy, a medical directive, a living will, or a combination of these.

READ MORE
Long-Term Care Insurance

Understand the ins and outs of insurance to cover the high cost of nursing home care, including when to buy it, how much to buy, and which spouse should get the coverage.

READ MORE
Medicare

Learn who qualifies for Medicare, what the program covers, all about Medicare Advantage, and how to supplement Medicare’s coverage.

READ MORE
Retirement Planning

We explain the five phases of retirement planning, the difference between a 401(k) and an IRA, types of investments, asset diversification, the required minimum distribution rules, and more.

READ MORE
Senior Living

Find out how to choose a nursing home or assisted living facility, when to fight a discharge, the rights of nursing home residents, all about reverse mortgages, and more.

READ MORE
Social Security

Get a solid grounding in Social Security, including who is eligible, how to apply, spousal benefits, the taxation of benefits, how work affects payments, and SSDI and SSI.

READ MORE
Special Needs Planning

Learn how a special needs trust can preserve assets for a person with disabilities without jeopardizing Medicaid and SSI, and how to plan for when caregivers are gone.

READ MORE
Veterans Benefits

Explore benefits for older veterans, including the VA’s disability pension benefit, aid and attendance, and long-term care coverage for veterans and surviving spouses.

READ MORE