WASHINGTON -- About 22 percent of the nation's nearly 16,000 nursing homes received the federal government's lowest rating in a new 5-star system unveiled Thursday, while 12 percent received the highest ranking possible.
A home could obtain 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 merely taking existing data already on the agency's Web site and making it easier for patients and families to choose 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," Weems said.
Officials also see 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" with a one indicating "much below average." The rankings will be updated quarterly. The industry is already questioning the validity of the rankings.
To nursing home operators, the five-star system is a great idea whose time has not yet come.
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 pressure sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.
Consumer groups like the concept, but they agreed there are some potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely 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."
Hedt said consumers should consider the star ratings, but not solely rely on them when comparing facilities. Her organization also issued a press release warning that nursing homes may appear in the ratings to 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.
But, in Indiana, eight nonprofit nursing homes have reported they got one star for staffing even though they have some of the highest staffing levels in the state, said Jim Leich, president and chief executive officer of the Indiana Association of Homes for the Aging. He believes the one-star rating is the result of a records glitch particular to any nursing home that is part of a campus that includes housing for residents with less intensive care needs.
"It's really going to be an injustice for some of our best facilities," he said.
The Jennings Center for Older Adults in Garfield Heights, Ohio, got four stars for its nursing home, said Martha Kutik, the center's president and CEO. Still, she's worried that the rating system relies on surveys that measure cracks in the ceiling but don't measure patient and family satisfaction.
"Any system that's going to measure quality for consumers should keep satisfaction high on the list," Kutik said.
CMS used three year's worth 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 for staffing reports the number of hours of nursing and other staff dedicated per patient each day. The measurement for quality looks at 10 areas, including the percent of patients with bed sores after their first 90 days in the nursing home and the number of residents whose mobility worsened after admission.
Weems said he expected criticism from individual nursing homes and their representatives in Washington.
"Criticisms are the path to improvement, so we hope to hear from them," Weems said.
