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Horizon Elder Law & Estate Planning Blog

Tuesday, April 12, 2022

Nursing Home Ratings: How to Find a High-Quality Home

The Centers for Medicare & Medicaid Services (CMS) created a Five-Star Quality Rating System “to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.” The rating system was a wealth of information, but one can easily get lost in so much data.

A California long-term-care planning attorney can help you plan and prepare for the move into a long-term care facility. Now, let’s talk about using nursing home ratings: how to find a high-quality home.

The Rating System

The CMS nursing home rating system uses a simple five-star rating methodology. Every nursing home gets a rating between 1 and 5 stars. The quality of a 1-star facility is far below average. The quality of a 5-star nursing home is far better than average.

The star rating system gets used for four purposes:

  • Overall quality of the nursing home.
  • Health inspection results from the three most recent inspections and investigations that were the result of complaints. The most recent inspections carry more weight than the previous years of surveys.
  • Staffing provided to residents. This category measures the average number of hours of care that the nursing staff provides to each resident every day. This category also considers the level of care needed based on the severity of the needs of the residents.
  • Quality measures. This rating covers 15 different measures on how well each long-term care facility meets the physical and clinical needs of its residents. Nine of the measures apply to long-stay residents, and six are relevant for short stays.

The CMS rating system cautions that it is impossible to include every possible topic that could help a specific individual assess which facility is best for that person. The CMS urges prospective residents and their families to visit the nursing homes in person and use the CMS rating as one of several criteria for evaluating nursing homes.

Quality Measures

The 15 quality measures are broken down by long-term and short-term stay data. Long-stay residents are those who live in the nursing home for longer than 100 days.

The Long-Stay subjects in the rating system include:

  • The number of hospitalizations per 1,000 long-stay resident days
  • The number of outpatient emergency department visits per 1,000 long-stay resident days

Also, there are measures that reveal the percentage of long-stay residents:

  • Whose need for help with daily activities has increased
  • Whose ability to move independently has worsened
  • Who have or had a catheter inserted and left in their bladder
  • With a urinary tract infection
  • Experiencing one or more falls with a significant injury
  • Got an antipsychotic medication
  • With pressure ulcers (bedsores) – this measure is of high-risk residents

Among short-stay residents (under 100 days), the CMA rating systems shares information from each nursing home about the:

  • Rate of successful return to home and community from a Skilled Nursing Facility (SNF)

and the percentage of short-stay residents who:

  • Improved in their ability to move around on their own
  • SNF residents with new or worsened pressure ulcers/pressure injuries (bedsores)
  • Got antipsychotic medication for the first time
  • Were re-hospitalized after a nursing home admission
  • Had an emergency department visit

Depending on your loved one’s situation, some of these quality measures, staffing data, health inspection reports, and overall quality ratings will be more critical for your evaluation of a long-term care facility.

Be sure to talk to a California estate planning attorney before your loved one enters a nursing home for guidance on things like Medicaid nursing home trusts and other documents that could protect you and your family. Contact our office today for legal assistance.


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