Don’t Be Misled by Medicare Star Ratings for Nursing Homes

medicare star ratings nursing homes

Medicare star ratings for nursing homes

Medicare’s online Nursing Home Compare lets you compare nursing homes that are certified to participate in Medicare or Medicaid. The search covers over 15,000 skilled nursing and rehab care facilities across the U.S.


Ken Chandler’s story

When Ken’s 90 year old mother was released from the hospital after breaking her leg, he chose Rosewood, a Medicare 5-star rated nursing and rehab facility close to their home in Sacramento, CA. What he didn’t know was that Rosewood already had over 100 consumer complaints.

While staying at Rosewood, Ken’s mom fell 11 times, developed repeated infections from not being toileted or bathed, and lost 40 pounds from her already thin frame. Watch the New York Times video (8 min) to hear Ken’s story.


New York Times finds the rating system is seriously flawed

The Medicare star ratings are the industry gold standard, but are mostly based on information that’s self-reported by nursing homes and isn’t verified by the government. The ratings also don’t include lots of potentially negative information, including fines and other state penalties as well as consumer complaints filed with state agencies.

Three criteria are used to determine the star ratings. Only one of them, annual health inspections, comes from an assessment by an independent reviewer. The other two, staff levels and quality statistics, are reported by the nursing homes and accepted by Medicare without verification.


Some nursing homes are gaming the system

Some nursing homes use the rating system to their advantage. Out of 50+ nursing homes on a federal watch list for quality problems, almost two-thirds have 4 or 5-star ratings for staff levels and quality statistics. But, more than 95% of the homes on the watch list got only 1 or 2 stars for the independent health inspection conducted by state workers.

“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures.” — Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy

Bottom line

Before choosing a facility, do your best to visit in person. Also check with state agencies and the ombudsman’s office to see if that facility has had complaints, fines, or penalties. Don’t take any one rating system at face value before you know how those ratings were awarded.

A geriatric care manager (GCM) is an expert who can help you evaluate and choose the best facility. If you can’t do the legwork yourself, investing in a good GCM can save you from making a big mistake.


Next Step  Read the full story at the New York Times


By DailyCaring Editorial Staff
Image: ProPublica

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