What is the Five-Star Rating System for Nursing Homes?

The five-star rating system for nursing homes was introduced by the U.S. government in 2009 to help families find high-quality nursing home care for their elderly loved ones. However, placing a loved one in a five-star rated facility does not guarantee they will be safe from nursing home negligence. Studies have revealed flaws in the five-star system that allow negligence and abuse to continue, even in top-rated facilities. It is important for families of residents to understand what the rating system means and to always be vigilant for signs of nursing home abuse. If a family has reason to believe that a loved one has been a victim of nursing home negligence, they should reach out to an experienced lawyer.

How Does the Rating System Help Consumers Compare Nursing Homes?

The five-star rating system helps consumers compare nursing homes by grading each facility according to various criteria developed by the Centers for Medicare and Medicaid Services (CMS).

• The CMS considers facilities with five stars to be well above average in quality.
• Nursing homes with a one-star rating are considered below average.

Each nursing home is assigned an overall rating as well as separate ratings for each of the following categories:

• Staffing. This rating grades the hours of care provided on average to each resident by nursing staff. The formulas used factor in varying levels of care that are required by different types of patients. Facilities whose residents have greater needs are expected to have more nursing staff per resident than those facilities in which the residents are more self-sufficient.
• Health inspections. The health inspection rating contains results of the three most recent inspections and investigations because of complaints. The most recent survey findings are weighted more heavily than those of prior years.
• Quality measures. This rating examines a number of physical and clinical measures, which differ depending how the facility categorizes the resident:  short-stay, 100 days or less; or long-stay, more than 100 days.

There are more than a dozen quality measures in each category. Examples of quality measures include but are not limited to the following:

• Percentage of residents who experience falls
• Percentage of residents who get flu shots or pneumonia vaccines
• Percentage of residents with pressure ulcers
• Percentage of residents taking antipsychotic medicine
• Percentage of residents re-hospitalized after nursing home admission

Long-stay quality measures also include the number of hospitalizations or emergency room visits per 1,000 days, percentage of residents who need to be restrained, percentage of residents whose ability to move independently has worsened, and percentage of residents with symptoms of depression.

On paper, the rating system for quality measures, staffing, and health inspection appears straightforward and comprehensive. More than 15,000 nursing homes across the United States have been rated using this system. However, nursing home abuse and negligence continues to occur even at facilities that receive five-star ratings.

What Potential Problems Exist in the Five-Star Rating System?

The five-star rating system has a number of potential problems, including flaws in data collection methods and the scheduling of health inspections. First and foremost, nursing homes themselves self-report their results for staffing and quality measures. The federal government rarely audits the data provided by the nursing homes to verify its accuracy. Second, nursing homes may be warned in advanced when health inspections are scheduled. This allows the facility to prepare and temporarily fix problems prior to the inspectors’ visits.

According to a 2021 investigation by the New York Times, residents of five-star nursing homes were just as likely to die of the Coronavirus (COVID-19) during the pandemic as residents of facilities that received a one-star rating. Moreover, more than two-thirds of five-star nursing homes were cited for problems with abuse and/or infections.

Part of the New York Times investigation involved analyzing millions of payroll records to verify the accuracy of staffing levels reported by more than 10,000 nursing homes. The journalists also examined information from academic researchers who have access to CMS data that is not publicly available. The findings found that some nursing homes provided misleading data, including but not limited to the following:

• Inflating staffing levels by including employees who are on vacation
• Including administrators in counts of nursing staff
• Understating the number of patients on antipsychotic medications
• Failing to report falls and other accidents

Also, the investigation found that some health inspectors found incidents of abuse but did not factor them into the ratings.

What are the Incentives for Nursing Homes to Inflate Ratings?

For-profit companies own approximately 70 percent of the nursing homes in the United States. Increased profits provide the incentives for nursing homes to inflate ratings. According to the New York Times study, five-star nursing homes earn about $2,000 in profits per resident in 2019, whereas those with only three or four stars earned an average of $1,000 in profits. Facilities with lower ratings were even less profitable.

How can Families Ensure the Safety of Loved Ones in Nursing Homes?

Although the five-star rating system is intended to help families choose a quality nursing home, a top rating does not guarantee freedom from abuse or neglect. Families can ensure the safety of loved ones in a nursing home by learning about their rights, remaining aware of their loved one’s condition, and actively looking for signs of nursing home negligence.

Although some signs of abuse are obvious, including bruises, broken bones, or bedsores, others might be more subtle, including dehydration, confusion, agitation, fear of speaking in front of staff, and unexplained infections.

Nursing homes are intended to provide a valuable service by caring for elderly and other vulnerable individuals who are unable to live without assistance. Unfortunately, short staffing at for-profit nursing homes is all too common, according to the New England Journal of Medicine (NEJM), leading to incidents of neglect.

The COVID-19 pandemic has put an even greater financial squeeze on nursing homes, requiring additional purchases of personal protective equipment (PPE), test kits, and other supplies. This incentivizes nursing homes to reduce staffing and training.

Families of nursing home residents who receive Medicare or Medicaid payments are guaranteed rights and a standard of care under the Nursing Home Reform Act (NHRA). Nursing home facilities must provide residents with written notice of their rights and protections that are guaranteed by law.

What Should I Do if I Suspect Nursing Home Negligence?

If a family suspects that a loved one is a victim of nursing home negligence, they should report it promptly to the nursing home administrator and head nurse. If the resident is in immediate danger, someone should call 911. The resident’s medical condition should be documented with photos or notes, and the family should record any subsequent medical treatment provided as well as the administrator’s and nurse’s response to the report.

Next, the family should contact an experienced nursing home negligence lawyer and ask for help regarding next steps. The lawyer should be provided with the evidence that the family has collected that documents the abuse. A qualified lawyer can then determine whether the evidence provides sufficient grounds for a nursing home abuse claim.

Philadelphia Nursing Home Negligence Lawyers at Galfand Berger LLP Stand Up for Vulnerable Residents Who Have Suffered Abuse

Nursing home facilities that receive Medicaid and Medicare payments are required by law to protect the safety and well-being of their residents. If you suspect that your loved one has been subjected to abuse or neglect in a long-term care facility, contact the Philadelphia nursing home negligence lawyers at Galfand Berger LLP today. Our compassionate legal team is dedicated to protecting the rights and dignity of vulnerable nursing home residents. To schedule a free and confidential consultation, call us at 800-222-USWA (8792) or contact us online. From our offices in Philadelphia, Bethlehem, Lancaster, and Reading, Pennsylvania, we proudly serve clients throughout Pennsylvania and New Jersey, including Allentown and Harrisburg.