There are over 15,500 nursing homes in the United States that are certified to provide care to Medicare or Medicaid beneficiaries (92% of the nursing homes are certified by both), which provide care for approximately 1.3 million residents every day. Seventy-percent of those nursing homes are for-profit; only twenty-four percent are non-profit. Ninety-five percent of nursing homes are free-standing facilities; only five percent of nursing homes are located within hospitals. The average certified nursing home has 106 beds (almost thirty percent of nursing homes have more than 120 beds).
CMS (Centers for Medicare and Medicaid Services) has been promoting its “Five-Star Quality Rating System” on its “Nursing Home Compare” website since 2008, to help individuals and their families find information regarding care provided by local nursing homes throughout the United States that would assist them in comparing and choosing local nursing home care. The five-star rating system awards five stars to the best performing nursing homes and one star to the lowest performing (the star-ratings are based on three measures, each of which is also based on a five-star rating system: state health inspections reports, staffing ratios (the ratio of nurses to residents that is measured by nurse hours per resident days, adjusted for resident care needs based on resident acuity levels), and quality measures (based on eleven measures from the Minimum Data Set (MDS), which assesses and documents the functional level and health status of residents)).
Until recently, so many of the nursing homes in the U.S. were rated four or five stars on the Nursing Home Compare website (seventy-eight percent were rated four or five stars in the quality measures category, and fifty-four percent of all nursing homes received overall ratings of four or five stars) that it was difficult for consumers to compare the care provided by nursing homes in their communities. CMS recently modified its method of rating nursing homes, placing more emphasis on deficiencies found by state inspections and less emphasis on self-reported data from nursing homes (CMS increased the number of points required to earn two or more stars for quality measures, changed its scoring method for staffing, and added two new indicators for quality measures that focus on the use of antipsychotic medications for short- and long-term residents). Future proposed changes include calculating staffing ratios based on electronic payroll reporting instead of relying on nursing homes to self-report their staffing ratios.
As a result, many nursing homes have suffered a loss of one or two stars in recent ratings. However, there is ongoing controversy regarding the current ratings methodology, for which CMS has indicated it intends to further tweak the ratings system to make it more reliable.
A recently published analysis by The Henry J. Kaiser Family Foundation (“Kaiser Foundation”) looked at the Nursing Home Compare database that was released in February 2015. The Kaiser Foundation reported the following findings in its “Reading The Stars: Nursing Home Quality Star Ratings, Nationally and by State”:
1) More than one-third of nursing homes certified by Medicare or Medicaid have relatively low overall star ratings of 1 or 2 stars, accounting for 39 percent of all nursing home residents. Conversely, 45 percent of nursing homes have overall ratings of 4 or 5 stars, accounting for 41 percent of all nursing home residents.
2) For-profit nursing homes, which are more prevalent, tend to have lower star ratings than non-profit nursing homes. Smaller nursing homes (with fewer beds) tend to have higher star ratings than larger nursing homes.
3) Ratings tend to be higher for measures that are self-reported (quality measures and staffing levels) than for measures derived from state health inspections.
4) In 11 states, at least 40 percent of nursing homes in the state have relatively low ratings (1 or 2 stars). In 22 states and the District of Columbia, at least 50 percent of the nursing homes in the state have relatively high overall ratings (4 or 5 stars).
5) States that have higher proportions of low-income seniors tend to have lower-rated nursing homes.
If you or a loved one suffered injuries (or worse) due to nursing home abuse, nursing home neglect, and/or nursing home negligence in the United States, you should promptly find a nursing home claim lawyer in your state who may investigate your nursing home claim for you and represent you or your loved one in a nursing home case, if appropriate.
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