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Your feelings on the CMS Five-Star Rating System

July 15, 2008
by Kevin Kolus
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I don't think any of the compare systems work because they are based on data submitted and not every facility codes the same, and not every state's surveyors survey the same. You are not comparing apples with apples. I don't think it is an accurate system. -

We are a very small nursing home and any issues cause the statistics to be skewed to present a negative image. -

It's utterly ridiculous and based on a document which points out a facility's shortcomings, not on what they excel at but what they need improvement on. We are NOT hotels and shouldn't be rated in the same system. -

I need to see the exact criterion that will be utilized for the rating scale—many of the QI/QM statistics do not indicate quality but rather just identify demographics or resident population characteristics. Do you disagree with what's been said? Speak your mind on the rating system!

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The 5 star system is an overly simplistic way to rate nursing homes. The 3 elements of the proposed "Quality of Care and Safety Information" are problematic (http://www.cms.hhs.gov/SurveyCertificationGenInfo/Downloads/ImprovingNHC...). QMs/QIs are not risk adjusted which biases nursing homes that are safety-net providers and providers that care for the most frail and medically complex residents/patients. Furthermore inspection/survey processes within states are wraught with inconsistencies which are multiplied 50-fold when you consider inconsistencies between states. Finally, staffing levels do not reflect total care. They only represent nursing services. A more complete picture would also address physician staffing and therapies including respiratory for those ventilator programs.

I'm relatively new to this industry but would love to read some comments on how actual resident and associated family and friends reviews could/should be accounted for in this type of survey? www.elderstep.com seems to be making an attempt at a www.tripadvisor.com approach. Any thoughts?

It is so obviously a flawed system. Surveys are subject to the surveyors latest training, sometimes impossible standards and the confusion of conflicting rules and regulations with safety and dignity issues. Its a damned if you do, damned if you don't atmosphere.
I feel turnover ratios are another area that can be location driven. If I'm in a small rural town and the nursing home is the only game in town, of course I stay for ever and ever. If I am in an urban area, a good share of the CNA staff are using the CNA job as a stepping stone to another health care or related field, as they go to school and have a job with fairly flexible hours.
It will take a lot more work and understanding of nursing homes to get a rating system that is a true reflection of the quality of care that is offered.

Kevin Kolus

Kevin Kolus

@longtermliving

www.ltlmagazine.com/blog/kevin-kolus

Kevin Kolus wrote for Long-Term Living when he was an editor. He left the brand in 2012...