New nursing-home ranking system stirs industry debate


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

A home could get up to five stars based on criteria such as staffing and how well they 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 taking existing data on the agency's Web site and making it easier for patients and families to evaluate a nursing home. He said it can be difficult for people to understand all the aspects of an inspection.

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

Officials also view 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." One is "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 Association 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 bedsores.

The nursing homes will receive stars for each category as well as for overall quality.

Consumer groups like the idea but agreed there could be problems with the data. For example, the staffing data are self-reported just before state surveys and is 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 Web site and pulling it into an easier system for consumers to use, and that is a good thing."

Ms. Hedt said consumers should look at the ratings, but not solely rely on them when comparing the facilities. Her organization also warned that the homes' ratings may make it seem that the facilities give better care than they actually do.

"Our initial reaction is that consumers should probably avoid any facility with a one or two-star rating, and even a three-star rating unless people they trust convince them that the rating is inaccurate or unfair," she said.

Information on Medicare's nursing home comparison Web site - - is easier to assess.

In Lucas County, for example, star-rating information is available for 37 nursing homes. Of those, nine were rated with just one star; 10 with two; nine with three; three with four, and six with five stars, the highest.

The new rating system, however, should be used with caution because a nursing home's quality can shift from month to month, warned the National Senior Citizens Law Center, an advocacy group.

No matter how many stars a nursing home has, residents and their loved ones must continue to be "politely aggressive" about receiving good care, it said.

"The squeaky wheel does indeed get the grease," Eric Carlson, the director of the center's long-term care project, said in a statement.

CMS used three years of inspections to rate nursing homes based on an annual survey designed to measure how well homes protect the health and safety of their residents.

The measurement of staffing reports the number of hours of nursing and other staff dedicated per patient each day.

The measurement of quality assesses 10 areas, including the percentage of patients who have bedsores after their first 90 days in the nursing home and the number of residents whose mobility worsened after their admission.