The lower five-star ratings for nursing homes that were forecast in February by the federal government are evidenced in a new analysis by the Kaiser Family Foundation. That analysis found that more than one-third of the nation’s 15,500 nursing homes, caring for 39 percent of all nursing home residents, received one- or two-star ratings under the Centers for Medicare & Medicaid Services’ (CMS’) recently revamped five-star quality rating system.
The news is making headlines in general media outlets but is not surprising, maintain two organizations representing providers.
“Nothing about the [nursing] centers and the quality of care being delivered has changed,” Greg Crist, senior vice president of public affairs for the American Health Care Association (AHCA), tells Long-Term Living, adding that consumers should not be alarmed. “What CMS did was recalibrated, which caused some centers to lose a star on paper. Across the board, skilled nursing centers have improved in quality, and what CMS has done has adjusted its five-star ratings to reflect that.” AHCA represents for-profit and not-for-profit providers.
In February, CMS announced the changes to its Nursing Home Compare website for consumers, incorporating measures related to the use of antipsychotic medications into the five-star ratings used on the site as well as changing calculations related to quality and staffing. At the time, CMS indicated that the changes would mean that several nursing homes would receive lower ratings even though their quality had not changed. CMS even posted information on its website to explain the new ratings to consumers.
Even after the changes, more than half of nursing homes remain four- or five-star centers, Crist notes. “We feel good about that,” he says, adding that AHCA’s recently extended quality initiative will lead to further improvements. “We're going to continue to hit high marks in quality.”
The Kaiser study, based on an analysis of star ratings in the Nursing Home Compare database, found higher overall ratings among non-profit nursing homes, with one-third of such nursing homes earning five stars compared with 18 percent of for-profit homes. It also found generally higher ratings for nursing homes with fewer beds than larger homes. Thirty-nine percent of nursing homes with fewer than 60 beds received a five-star rating compared with 14 percent of nursing homes with more than 120 beds.
LeadingAge, which represents not-for-profit providers of care and services, tells Long-Term Living that the organization’s position on the topic has not changed since 2012, when its president and CEO, Larry Minnix responded to lists published by U.S. News & World Report and USA Today. At the time, he wrote: “When I look at the U.S. News list of those home consistently receiving 5 stars, most are from states with more generous Medicaid reimbursement rates and the vast majority are not-for-profits. When I look at USA Today’s list of repeated 1-star homes, most are from states with poor reimbursement rates and are for-profit.” Quality, Minnix added, depends on sponsorship, staffing and adequate reimbursement.
The Kaiser report also documents considerable variation in nursing home ratings across the states. In 22 states and the District of Columbia, for example, at least half of nursing homes received ratings of four or five stars. In 11 states, however, more than 40 percent of nursing homes received ratings of one or two stars. The states with the greatest share of lower-rated nursing homes include Texas, where 51 percent of all nursing homes received a one- or two-star rating, followed by Louisiana (49 percent) and Georgia, Oklahoma and West Virginia (46 percent each). In nine states, at least one in five nursing homes received one star, the lowest possible rating.
At the county level, two-thirds of all counties in the United States had at least one nursing home with a four- or five- star rating, whereas the remaining one-third of counties have only nursing homes rated with fewer stars (27 percent) or no Medicare or Medicaid-certified nursing homes at all (seven percent).
For the full analysis, see Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State.