How To Interpret The 5-Star Rating System

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Earlier this month, I asked my newsletter subscribers to email me with suggestions for topics they would like to see addressed on my blog. One reader submitted an excellent question about the 5-star rating system for nursing homes. She also wanted to know if I believe it’s an accurate predictor of the quality of care provided to the residents.

Perhaps some of you aren’t familiar with this program, so today I’ll attempt to summarize how it works.

What is the purpose of the 5-star rating system?

The 5-star rating system is a part of Nursing Home Compare which was developed by the government in 2008. It provides a means for consumers to evaluate and choose a nursing home for themselves or a loved one.

Anybody can go to the website, enter a city/state or zip code, and see the star ratings for all area nursing homes that are Medicaid and Medicare certified.

The system also helps nursing homes identify their strengths and weaknesses to improve the quality of their care.

How is a nursing home’s rating determined?

The algorithm that determines each facility’s rating is rather complicated. For this post, I’ll summarize the main points.

The 5-star rating is based on each of the following 3 criteria. An overall score is also calculated.

• Health and fire safety inspections

This score results from nursing home inspections done by state agencies. The reports include information from health surveys as well as fire safety inspections. (Please refer to this article for more information on what’s involved in a nursing home survey.)

These include routine inspections, surveys triggered by complaints, and follow-up inspections done to assure correction of deficiencies. Additional reports on emergency preparedness were added in November of 2017.

• Staffing

Information regarding staffing reflects the average number of hours of care provided to residents by RNs, LPNs, and nursing assistants.

• Quality of resident care

This category reflects information from clinical assessments done on each resident by the nursing home. It looks at specific areas believed to be indicators of the quality of care. A few of these include unintended weight loss, pain, falls, and loss of bowel or bladder control.

What do the 5 stars mean?

The system compares nursing homes within each state and gives every facility a score based on this ranking:

1= Much below average

2= Below average

3= Average

4= Above average

5= Much above average

My opinion of the 5-star system

I’ve watched the 5-star ratings for nursing homes in our area for many years, both as a nurse manager and now as a volunteer. In general, I find that the number of stars a facility receives usually matches the reputation of the nursing home within the community.

That being said, we sometimes hear stories of bad things happening at 5-star homes. And I’ve also heard families express high praise for nursing homes that only received two stars.

I think one of the most important things to remember is that the ratings are based purely on objective information. The system can’t look at kindness, compassion, patience, or other traits that are so valuable in caregivers.

In summary, I believe the 5-star rating is only one of several tools to use when choosing a nursing home. Sometimes the decision needs to happen very quickly, but if at all possible, I encourage you to visit the facility in person.

The Medicare website provides an excellent checklist to help you with this task. You can print copies here and bring them along when you visit the facility.

What’s your opinion of the 5-star system? Whether you’re a resident, family member, or nursing home employee, I would love to hear your comments!