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How Reliable is the Government Star Rating for Nursing Homes?

March 19, 2019

By Van Der Veen, Hartshorn, and Levin

Making the decision to place a loved one in a nursing home is a difficulty many families face. First and foremost, families want to ensure their loved one will be given quality care by supportive staff. Part of that of course, is ensuring that a nursing home follows state and federal laws.

The laws pertaining to nursing homes though, are many. It can be difficult for individuals to sort through them, know what questions to ask, and what to look for. It’s for this reason that Medicare and Medicaid Services have been rating nursing homes since 1998, and making those ratings publicly available.

However, those ratings have often been called into question. How accurate are they, and what factors are considered?

How the Ranking System Works

When rating nursing homes, Medicare and Medicaid take federal and state requirements into consideration. They then rate a nursing home according to health inspections, staffing ratios, and quality measures.

The quality measures score is based on 18 different factors found in the report, Design for Nursing Home Compare Five-Star Quality Rating System. This is a report that’s been written by Centers for Medicare & Medicaid Services. Some of the criteria included in this portion of a nursing home’s rank include:

  • The number of residents in need of help with daily activities,
  • The percentage of residents with bed sores, or at risk for bed sores,
  • Number of patients physically restrained,
  • Number of patients with a urinary tract infection,
  • Number of patients living with moderate to severe pain, and
  • Number of residents that have fallen at least once in the facility

Of course, quality measures are just one part of the government’s nursing home rankings. Health inspections are also considered. This portion of the ranking will be determined based on the outcome of health inspection reports that mostly detail how clean and safe a facility is kept.

Lastly, staffing ratios are also taken into consideration. Nursing homes need to ensure they have an appropriate number of staff to properly help all of their residents. When they fail to do so, their ranking will drop.

On the surface, the government’s measurements for rating nursing homes seems reasonable. So, why has it been criticized in the past?

Criticisms to Medicaid and Medicare’s Nursing Home Ranking System

One of the biggest problems with the government’s ranking system is that the nursing homes themselves often self-report on different criteria. They are most likely to do this with staffing ratios, a hefty consideration when ranking a nursing home. Nursing homes may state they had more staff on at any one time than they actually did in order to get a higher ranking.

Another problem with the ranking system Medicaid and Medicare use is that some factors influence the overall ranking more than others. A large part of the ranking for example, is made up of the health inspection results. Quality measures, which outline the actual care a person is receiving, are not given the same weight as health inspections.

This means that while a nursing home may have a ranking of just one or two in quality measures, a high health inspection score increases their overall rank to four or five stars. In Pennsylvania, approximately twenty percent of all facilities that have a high ranking also have a low quality measures score.

This is little comfort to family members relying on the government’s ranking system to find the perfect home for their loved one. These same family members may also be shocked to learn that a nursing home with a high ranking is suspected of abuse.

Contact a Philadelphia Nursing Home Abuse Lawyer that can Help

Suspecting possible abuse to a loved one in nursing home can be devastating for families. It’s a very emotional time, and family members are rightfully very angry. Before taking any further steps though, it’s important loved ones speak to a nursing home abuse attorney in Philadelphia that can help. At van der Veen, Hartshorn, Levin & Lindheim, we know the law surrounding nursing homes. If you suspect your loved one is being abused, call us today at (215) 486-0123 and we’ll start an investigation to determine if your loved one is being abused. Upon confirming the abuse, we will hold the nursing home and its staff responsible, and help you and your loved one collect the full amount of compensation you are entitled to. Contact us today so we can help protect your family.

Resource:­ Certification /CertificationandComplianc/clownloads/usersgu idc.pdf ht lps:// rsingho meco mpa re /search.htm I


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