Quality of Nation's Nursing Homes Improving under Five-Star Quality Rating System

DURHAM, NC—The quality of nursing homes has improved in most states and in the District of Columbia since the 2008 implementation of the Five-Star Quality Rating System by the Centers for Medicare & Medicaid Services (CMS), an Abt Associates' analysis finds.

The study shows that between 2009 and 2011, the percentage of nursing homes with an overall five-star rating, or much better than average quality, increased in all but three states and the proportion with a one-star rating, or much below average quality, dropped as well. There are more than 15,500 nursing homes in the country, and all of them are rated with between one and five stars.

"Between 2009 and 2011, the percentage of nursing homes with a four- or five-star rating grew in every state except for Hawaii, Montana, and Idaho," said Alan White, Ph.D., a principal associate at Abt Associates who worked with CMS to develop the rating system. "While we don't know the extent to which the existence of the rating system itself has led to this improvement, most nursing home operators pay close attention to their ratings and seem to be motivated to improve them. Some use their ratings as part of their marketing efforts, branding their facilities as 'five-star' nursing homes."

White said the Five-Star Quality Rating System was created to help consumers, their families, and caregivers more easily compare nursing homes when visiting CMS's Nursing Home Compare website.  There they can learn about a facility's overall performance rating and how it performs in three separate domains—health inspection surveys, staffing, and quality measures. The ratings are updated monthly.

While there has been an 8% increase in four-and five-star facilities in overall performance nationwide between 2009 and 2011, five states stand out as experiencing the greatest change in their proportion of nursing homes with a four- and five-star overall rating. These are Delaware, Tennessee, Georgia, Oregon and Indiana. The percentage of Delaware's five-star facilities jumped by nearly 23%; Tennessee's by about 16%; Georgia's by nearly 15%; and Oregon's and Indiana's each by about 14%.

In addition to overall performance, the study provides state ratings in each of the performance domains. Health inspection ratings are drawn from standard and complaint surveys over three years, White said, explaining that nursing homes are inspected every 12 months on average to ensure they are following state and federal regulations.

"The inspection surveys provide a comprehensive assessment of the nursing home, examining such areas as kitchen/food service, medication management, proper skin care, and the safety, functionality, cleanliness and comfort of the environment." White said.  "If an inspection team finds that a nursing home doesn't meet a specific standard, it issues a deficiency citation, and the health inspection rating is based on the number and severity of deficiencies cited by surveyors."

The staffing rating, said White, is based on the number of hours of care on average provided to each resident each day by nursing staff.  "The ratings consider differences in how sick the nursing home residents are in each nursing home, since that makes a difference in how many staff members are needed."

The quality measures rating is an assessment of nine different physical and clinical measures for nursing home residents that indicates how well nursing homes perform on important dimensions of care related to each resident's functioning and health status.

While the Five-Star Quality Rating System can help consumers, their families and caregivers compare nursing homes more easily, White cautioned that it cannot address all of the considerations that go into deciding which nursing home is best for a particular individual. "The rating system is an excellent tool but it should be used in combination with other sources of information, including an onsite visit, in making nursing home placement decisions," he said.

Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators.  The company has multiple offices in the U.S. and program offices in more than 40 countries. www.abtassociates.com