California nursing homes to begin posting federal star ratings


Patients and visitors at California nursing homes will be greeted with something new come the new year: publicly posted ratings of each facility. The federal ratings give facilities one to five stars depending on quality of care, much like restaurants display letter grades evaluating health and safety compliance.

The new law is intended to ensure that patients and their families are aware of the evaluations. Nursing home officials also must post information explaining the ratings and how to obtain information about the nursing home’s state licensing record from the Department of Public Health’s website. Facilities that fail to follow the law face a range of potential fines.

California will be the first state in the nation to mandate posting of the ratings, which went into effect in 2008 and are designed to evaluate and compare the quality of nursing homes.


The legislation, sponsored by Assemblymen Cameron Smyth (R- Santa Clarita) and Mike Feuer (D- Los Angeles), faced opposition from patient advocates and nursing home officials. Critics fault the federal ratings for failing to include recent state violations and also say the star ratings unfairly penalize well-run nursing homes that care for the most critically ill patients for failing to improve their condition.

California is home to 1,235 federally rated nursing homes, more than any other state. Of those, 195 got the lowest rating, one star, and 187 got five stars. The new law will affect about 400 nursing homes in Los Angeles County serving about 30,000 people.

Los Angeles County’s five-member Board of Supervisors unanimously voted in January to encourage Gov. Arnold Schwarzenegger and state health department officials to post the ratings.

“In addition to providing incentives for operators to establish and maintain high-quality standards of care and compliance, this vital five-star rating system improves care for the patient by providing the information families need to make informed decisions when selecting a facility to meet the needs of their loved ones,” said Supervisor Michael D. Antonovich.

But patient advocates and nursing home officials said they remain dissatisfied with the ratings, which they hope federal officials will improve during the coming year.

Federal officials initially scored nursing homes based on quality, staffing and inspections, issuing the top 10% of facilities in each category nationwide five stars, the bottom 20% one star and the middle 70% two, three or four stars, with an equal proportion in each category, about 23%. They have since adjusted staffing and quality measures so that nursing homes that improve can boost their star rating, according to a spokesman for the Centers for Medicare and Medicaid Services.


Nursing home officials complain that the scoring system does not accurately reflect a facility’s quality.

“It should just be a straight rating in a free-market system where you get stars based on performance,” said Mary Jann, director of regulatory affairs for the Sacramento-based California Assn. of Health Facilities, which represents about 800 skilled nursing facilities statewide.

Jann said federal officials have told her they are in the process of revising the ratings, but they have yet to provide specifics.

“The quality measures are changing,” said Edward Mortimore, technical director of the survey and certification group in the Baltimore office of the Centers for Medicare and Medicaid Services. “We’re still evaluating what will happen.”

Mortimore said the ratings could be frozen or temporarily eliminated from April to next fall while improvements are made. It was not clear what information nursing homes would be required to post during that time.

Patient advocates hope the federal improvements to the ratings will include incorporating state public health complaints and citations.


But even if they do, the ratings are no replacement for seeing a nursing home and speaking with managers and staff, said Pat McGinnis, executive director of California Advocates for Nursing Home Reform, which has offices in Pasadena and San Francisco.

“I don’t think anyone can pick a nursing home using a ratings system — it’s not like picking a car. There’s so many factors involved,” McGinnis said. “We tell people this is an indicator, one of many, and nothing’s going to substitute for your own personal visit.”

Feuer said he worked with nursing home officials and patient advocates to shape the law, and although the ratings need to be refined, it was important to provide as much information as possible now.

“Having as much information available as possible is crucial when families and patients are making what could literally be a life-or-death decision,” Feuer said. “There’s much more we need to do in terms of the quality of care at nursing homes, but it begins with patients and their families making the right decision.”