How Accurate is Medicare’s Rating System for Nursing Homes

Contemplated how accurate is Medicare’s rating system for nursing homes? The NY Times recently published an article discussing the fact that Medicare’s ratings of nursing homes cannot be trusted to give accurate information – NY Times Article. Medicare has a rating system (the highest being 5 stars) that it assigns to nursing homes around the country which assess a facility’s staffing, health inspection and quality measure ratings. However, according to the article, this “seal of approval” is based on incomplete information because it mostly relies upon self-reported data which the Centers for Medicare and Medicaid Services does not verify. Two thirds of the information Medicare relies upon for its ratings is self-reported information reported by the facilities (this includes staff levels and quality statistics).

Why are these ratings important? According to the NY Times article, doctors and nurses consider these ratings when referring patients to a nursing home for rehab. Insurers also use these ratings in determining whether to add the facility to their preferred networks. Even investors and lenders look at these ratings when determining whether to lend money or invest in the nursing home company.

So what are some other ways to determine whether the nursing home your loved one is entering is a good one or not? Florida’s Agency for Health Care Administration (AHCA) also has a consumer guide and assigns a 5 star rating. The inspection results are based on quality of care, qualify of life and administration concerns. You can also see the facility’s performance based upon past inspection results. AHCA’s website discusses how the score is reached based on inspections made by AHCA, on average, once per year. Thus, their ratings do not appear to be based mostly on self-reported information. AHCA also has a “watch list” which can be sorted by city or zip code and shows those facilities which are operating under bankruptcy protection or did not meet, or correct upon follow-up, the minimum standards of an inspection.

If you are not confident of the information published by AHCA, I also suggest working with a geriatric care manager or even a nursing home placement company to help you find a facility that meets your loved one’s needs. A geriatric care manager can help guide a family as to the type of care a family member may need (maybe you are not sure if they can be in assisted living vs. skilled nursing) and can help problem solve if the family member is having health care issues or questions.

Finally, I also suggest visiting the nursing homes or assisted living facilities where you are considering placement of your loved. Some questions to ask include: What are the visiting hours and can we visit any time? What kinds of activities are there for the residents? What security measures are in place to keep my loved one from wandering (if that is an issue)? Are pets allowed? Also look at how the staff treats the residents – are there sufficient amount of staff for the residents? Do they spend time with the residents? If you are shown a resident’s room, notice how it is decorated, does it have windows, and is it large enough to accommodate a wheel chair?

The Alzheimer’s Association has a guide about what to look for and what to ask when looking for a nursing home (and it can be used in any situation, including if your loved one needs a dementia-type facility) – click here .

Laurie Ohall is a Florida Board Certified Elder Law Attorney based in Brandon, Florida.  Contact Ms. Ohall today if you need estate planningelder lawprobate or guardianship assistance.