Making Sense of the Medicare 5-Star Rating System for Nursing Homes

In working with patients and their families, you have likely been asked for advice on which nursing home or skilled nursing and rehab center is the best one in your local area. Most health care professionals are reluctant to make recommendations for a variety of reasons. Fortunately, the Medicare 5-Star Quality Ratings can give you something to share with families researching their options.

How Reviews are Determined

Medicare uses three components when ranking skilled nursing and rehab centers. They are:

• Health inspections and survey results – Medicare goes back three years to look at annual survey findings, as well as complaint surveys filed by staff, residents, and family members. Recent surveys and inspections receive more weight than older ones.
• Staffing ratios – Many people believe staffing levels are the key to quality care. Medicare evaluates two staffing measures. The first one is the number of Registered Nurse (RN) hours per resident day, and the other is the total staffing hours per resident day. Total staffing includes Registered Nurses, Licensed Practical Nurses, or Licensed Vocational Nurses and Certified Nurse Aids.
• Quality measure data – If you look at any of the communities on Nursing Home Compare, you will see 19 different quality measures. Medicare combines them in to nine quality measures and uses those to create the star rating for this area.

Each of the areas above is given its own star rating ranging from one star (the lowest) to five stars (the highest). These three areas are then combined and one overall star rating is determined.

Strengths and Limitations of the Five Star Rating System

As you might expect, there are some positives and some negatives to this system. On the positive side, all Medicare-certified skilled nursing communities are evaluated. A community cannot choose to opt-out of participating. Because state inspectors are all trained professionals, each provider is assessed by an expert using the same criteria.

On the down side, the state inspection process can vary on a state-by-state basis. In one state a three-star community might be considered a four-star in a state where inspectors don’t have the same level of expectations.

The bottom line is that the Medicare 5-Star Quality Review program is just a starting point. Families should always follow-up their online research with a personal visit to each of
the communities they are considering.

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