The Limitations of the Five-Star Quality Rating System
The Five-Star Quality Rating System, developed by the Centers for Medicare and Medicaid Services (CMS) in 2008, serves as a valuable resource for families seeking information about nursing home quality. However, it's crucial to understand that this rating system has its limitations and may not always provide the most reliable assessment. 
Factors Considered in the Five-Star Rating
The ratings are determined by a combination of self-reported data from nursing homes and on-site examinations conducted by state health inspectors. Several factors contribute to a nursing home's overall score or star rating, including:
- Inspection Results: The findings from inspections play a significant role in evaluating a nursing home's compliance with regulations and standards.
- Staffing Levels: The amount of time nurses spend with residents is taken into account to assess the quality of care provided.
- Quality of Care: This factor includes indicators such as the prevalence of pressure ulcers, use of antipsychotic medications, and vaccination rates among residents.
Concerns Raised by an Investigation
Despite its popularity, the Five-Star Quality Rating System has faced criticism due to concerns regarding data accuracy. A recent investigation by the New York Times shed light on potential issues with the rating system. The investigation revealed:
- Inaccurate Data Submission: Some nursing homes were found to have submitted false information in an attempt to portray themselves as safer and cleaner than they actually were.
- Exaggerated Staffing Levels: In certain cases, nursing homes falsely reported higher staffing levels to improve their ratings.
- Underreported Use of Potentially Hazardous Drugs: Instances where nursing homes failed to accurately report the use of medications with potential risks were uncovered.
- Minimized Reporting of Health Problems and Accidents: Some nursing homes downplayed or neglected reporting resident health problems and accidents.
Inspection Failures and Limited Auditing
The investigation found that even nursing homes with high ratings could fail inspections when assessed in person by CMS investigators. Additionally, the information submitted by nursing home operators and owners was rarely audited, raising concerns about the accuracy of the self-reported data. Furthermore, there were indications that unscheduled inspections may have been compromised, and violations at highly rated homes were often downplayed by inspectors.
Exercising Caution and Thorough Evaluation
Given the limitations and potential inaccuracies of the Five-Star Quality Rating System, it is crucial for individuals and families to exercise caution when relying solely on these ratings. It is advisable to thoroughly scrutinize all aspects of a potential nursing home before making a decision.
AARP provides a detailed checklist that can assist in evaluating nursing homes based on various criteria related to care quality, including long-term care planning considerations. The checklist can be downloaded here.
However, it's also important to consider other aspects related to nursing home care such as Medicaid Planning and Asset Protection. Understanding options like Medicaid asset protection trusts can significantly impact how one pays for long-term care expenses while preserving assets for future generations.
