The Centers for Medicare and Medicaid Services (CMS) created a five star rating system and ranks only nursing homes that are certified to participate in Medicare or Medicaid and provide skilled care. The ratings are based on health inspections, staffing, and quality measures.

How are ratings calculated?

CMS created the Overall 5-Star rating for nursing homes based on three areas: 1) Health Inspections; 2) Quality Measures (QMs); and 3) Staffing. Star ratings for each area and the overall rating range from 1 star to 5 stars, with more stars indicating better quality.

CMS describes each of the three domains below:

1.    Health Inspections rating:
CMS bases health inspection ratings on the three most recent anual inspections, and inspections due to complaints in the last three years. CMS weights greater emphasis on recent annual inspections.

2.    Quality Measures (QM) rating:
CMS combine the values on nine QMs derived from clinical and outcome data reported by the nursing home.

3.    Staffing rating:
CMS base the facility staffing rating on two measures: 1) Registered Nurse (RN) hours per resident day; and 2) total staffing hours per resident day. Total staffing includes: RNs; Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs); and Certified Nurse Aids (CNAs).

At all times, certified nursing homes must meet over 180 regulatory standards designed to protect nursing home residents. These standards cover a wide range of topics, from proper medication management, prevention of physical or mental abuse and inadequate care, to the safe storage and preparation of food.

The health inspection team consists of trained inspectors, including at least one registered nurse. These inspections take place, on average, about once a year, but may be done more often if the nursing home is performing poorly.

Fire safety specialists evaluate the facility’s performance on Life Safety Code (LSC) standards set by the National Fire Protection Agency (NFPA). The fire safety inspection covers a wide range of concerns, including construction, protection, and operational features designed to provide safety from fire, smoke, and panic. Nursing homes that have a waiver from the health occupancy provisions of the LSC or that have an acceptable Plan of Correction are considered “in compliance.”

State inspectors record their findings in a detailed inspection report (form HCFA-2567) which, in some cases, may be well over 100 pages. When the inspectors finds a deficiency, they record the specific reasons for the deficiency in this report.

Each nursing home that provides Medicare or Medicaid services is required to make available its last full inspection report. The entire report can be viewed at the facility or partial information can be found here.

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