New Rating System for Nursing Homes

Medicare Web Site Will Have Monthly Rankings of Thousands of Nursing Homes

From the WebMD Archives

Dec. 18, 2008 -- Federal officials unveiled a five-star rating system that for the first time ranks the quality of the nation's 15,800 nursing homes that participate in Medicare or Medicaid.

A nursing home reform group praised the move, calling it a step in the right direction for helping consumers evaluate nursing homes.

But a spokesman for the nursing home industry called the ranking system a great idea that is being prematurely implemented.

"They rushed this thing out there," Larry Minnix of the American Association of Home and Services for the Aging tells WebMD. "If they had spent more time thinking through the specifics, they would have a product that would be more useful to consumers."

Nursing Home Ranking System

The rating system is based on state and federal health inspection surveys, quality-of-care data, and staffing information.

A five-star ranking indicates that a nursing home is performing well above average and one star means a facility ranks well below average.

Rankings will be updated monthly and can be found at the Center for Medicare & Medicaid Services (CMS) web site ( under the search tool Compare Nursing Homes in Your Area.

In a morning news conference, CMS Acting Administrator Kerry Weems told reporters that the new rating system should give poor-performing nursing homes an incentive to improve the quality of the care they provide.

"I would expect that consumers with family members in a lower-performing facility would begin a conversation with the nursing home operator about why the facility scored low and what was going to be done about it," he said.

Weems revealed that:

  • 12% of the nation's federally assisted nursing homes received five stars in the first monthly rating.
  • 22% of the nursing homes got just one star.
  • 66% got two, three, or four stars.

In addition to the overall star rating, consumers can access detailed information about specific nursing homes through the web site.

"But it is important to emphasize that no rating system and no web site can substitute for families actually visiting the nursing homes they are considering for a family member," Weems said.


Industry: Rating System Flawed

Minnix says the five-star rating system is flawed because the information used to determine the rating often is flawed.

He points out that there is wide variation in the quality of the nursing home inspection process from state to state, which needs to be addressed at the federal level.

And while the staffing evaluation includes information on total staff numbers and staff hours spent with residents, it does not include information on personnel turnover, which is a big factor in continuity of care.

"If you have 100% turnover, or 50% of your staffers are [temporary] workers, the quality of the care is going to suffer," he says.

Alice H. Hedt of the consumer group National Citizens' Coalition for Nursing Home Reform says it will take time to evaluate how well the rating system reflects what is really going on in the nation's nursing homes.

She says consumers should definitely consult the star rating when evaluating a nursing home, but agreed that it should not be the only factor in choosing a home.

Hedt praised CMS for making previously hard-to-find information on nursing homes easily accessible.

"We encourage consumers to drill down into the information and find out what it says about inspections and staffing and quality measures," she tells WebMD.

She points out that all kinds of information is available, including the bed-sore rate and the rate of patient restraint at individual facilities.

"After I looked at the overview, I would look specifically at [bed] sore rates and restraint rates," she says. "If either of these rates are high, that is an indicator that there is a problem."

WebMD Health News Reviewed by Louise Chang, MD on December 18, 2008



Centers for Medicare and Medicaid Services press statement and teleconference, Dec. 18, 2008.

Kerry Weems, acting administrator, Centers for Medicare and Medicaid Services, Department of Health and Human Services.

Larry Minnix, president and chief executive officer, American Association of Homes and Services for the Aging.

Alice H. Hedt, executive director, National Citizens' Coalition for Nursing Home Reform.

© 2008 WebMD, LLC. All rights reserved.