ProPublica released unredacted write-ups of problems found during nursing home inspections around the country. For several months now, ProPublica has made redacted versions of this same information available in an easily searchable format in our Nursing Home Inspect tool. These versions, which reside on the U.S. Centers for Medicare and Medicaid Services website, Nursing Home Compare, sometimes blank out patients’ ages, medical conditions, dates and prescribed medications.
3.3 million Americans move into a nursing home each year. One in seven Americans age 65 and older will spend time in one of the nation’s 16,000 nursing homes this year and for those 85 and older, the chances are more than one in five. Finding one that provides quality care is a challenge. Best Nursing Homes highlights meaningful data, like what proportion of residents have bedsores or are in pain. Be leery of nursing homes that the government has labeled Special Focus Facilities. In Best Nursing Homes, facilities in this category are flagged with an icon that indicates they’ve been singled out by the state where they operate and by CMS as nursing homes with long histories of subpar or inconsistent health inspections.
The U.S. News rankings are built on data from Nursing Home Compare, a consumer web site run by the federal Centers for Medicare and Medicaid Services. CMS sets and enforces standards for all nursing homes enrolled in Medicare or Medicaid. The data for Nursing Home Compare come from regular health inspections carried out by state agencies and from the homes themselves. Based onthat information, CMS assigns an overall ratings of one to five stars to all nursing homes other than a few too new for meaningful data to be available. Homes are also given one to five stars in how well they do in the health inspections, in providing enough nurses, and providing a high level of quality of care.
At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code.
Here are more details about the CMS standards that determine a home’s rating:
Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents’ rights and quality of life, and proper skin care. A home’s rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame.
Even first-rate nursing care falls short if there isn’t enough of it because of too few nurses who can spend time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. To receive five stars in the latest CMS ratings, nurses and aides had to provide slightly more than four hours of care a day to each resident, including 33 minutes from registered nurses. The time provided by each home is shown in the rankings.
CMS requires nursing homes have to submit clinical data for the most recent three quarters detailing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair.
USA Today reported that more than 560 of the nation’s nursing homes have not improved care for the past three years from a one-star federal government rating — the lowest on a five-star scale — even though most homes improved, according to a USA TODAY analysis of federal data. See ratings for nursing homes.
The lowest overall rating is awarded to homes "much below average" compared with others in their state, according to CMS. The star ratings are part of a broader federal effort to increase transparency for consumers of health care. The federal government contracts with states to inspect nursing homes about once a year. The star ratings combine scores of data points, including information from annual inspections, quality measures and staff time spent with residents.
USA TODAY analyzed the ratings for 15,700 nursing homes for the past three years. Among the findings:
•Some homes are stuck at the bottom: 564 homes — representing 77,315 beds — received one star in each of seven reporting periods analyzed over three years. But 448 homes received the best overall rating — five stars — during each period.
•Among the consistently low performers, almost two-thirds were for-profit nursing homes that are owned by chains. That’s a higher share than the 40% of all nursing homes in for-profit chains.
Lower staff turnover can create better care because employees become familiar with the routines and needs of nursing home residents.
"The current nursing home quality measures of the Compare tool will be replaced with new quality measures based upon a new version of nursing home resident assessments, starting in 2012. The new measure will include input from the residents. As part of the transition to new quality measures, the 5 Star Quality Rating that the tool has provided will not include the new measurement until April 2012. Starting in April 2012, findings of the new assessment measures will be part of the 5 Star Quality Ratings."
Some of the other measures of nursing home quality that have been included in the Nursing Home Compare tool include staffing data and data from health inspections. As explained in a recent article, “Navigating the Health Care System,” by Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality (AHRQ), also part of HHS:
“Staffing and health inspection data add important information and will continue to be a factor in each nursing home’s overall rating. The staffing measure tells you the average staffing levels—such as the number of registered nurses, licensed practical nurses, and certified nursing assistants—for each resident each day. This is a good benchmark, but it has limits. It does not show the number of nursing staff present at any given time or describe the amount of care give to any one resident. The health inspection measure looks at many major aspects of care in a nursing home. This includes how medicines are managed, whether food is prepared safely, and whether residents are protected from inadequate care. Inspections take place about once a year, but they may be done more often if the nursing home has several problems to correct. ”