One-fifth of nursing homes rate ‘much below average’

About 22% of the nation’s nearly 16,000 nursing homes received the federal government’s lowest rating in a new five-star system unveiled Thursday, while 12% received the highest ranking possible.

A home could obtain up to five stars based on criteria such as staffing and how well it fared in state inspections. The lowest ranking possible was one star. Such a simple rating for so complex a task as caring for the elderly has led to much anxiety in the nursing home industry.

Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said the agency was merely taking existing data already on the agency’s website and making it easier for patients and families to evaluate a nursing home.

“This should help consumers in narrowing their choices, but nothing should substitute for visiting a nursing home when making a decision,” Weems said.

Officials also see the new rating system as a way to challenge nursing homes to improve the care they provide to nearly 1.5 million patients nationwide.

“Transparency is key when it comes to nursing home quality,” said Sen. Herb Kohl (D-Wis).

Under the new system, five stars means a nursing home ranks “much above average,” four star indicates “above average,” three means “about average,” two is “below average,” with a one indicating “much below average.” The rankings will be updated quarterly.

The industry is already questioning their validity. The system “is poorly planned, prematurely implemented and hamhandedly rolled out,” said Larry Minnix, president and chief executive officer of the American Assn. of Homes and Services for the Aging, an industry trade group.

The ratings are based on three major criteria: state inspections, staffing levels and quality measures, such as the percentage of residents with bed sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.

Consumer groups like the concept, but agree there are potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely recognized as unreliable.

“From a consumer viewpoint, it’s not stringent enough,” said Alice H. Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform. “It’s basically taking information already available on Medicare’s Nursing Home Compare website and pulling it into an easier system for consumers to use, and that is a good thing.”

The Jennings Center for Older Adults in Garfield Heights, Ohio, got four stars for its nursing home, said Martha Kutik, the center’s president and CEO.

Still, she’s worried that the rating system relies on surveys that measure cracks in the ceiling but not patient and family satisfaction.

“Any system that’s going to measure quality for consumers should keep satisfaction high on the list,” Kutik said.

Weems acknowledged that satisfaction levels are an important criteria.

“That’s something we would like to do in the future,” Weems said.