ratingsThe newspaper of record recently issued a scathing report against the nursing home five-star rating system.[1]

Medicare operates on a five-star rating system for nursing homes, where a top rating indicates the highest quality. However, nursing homes appear to be gaming the system to get higher star ratings than they deserve – calling into question the entire ratings system.

A rating system is used to help families evaluate a nursing home when deciding which facility to place a parent or loved one. The Medicare rating system uses three main data points to determine the star level: quality-of-care measures, staffing levels and health inspections.

According to the Times, nearly half of the nation’s nursing homes had either a 4- or 5-star rating. More shockingly, two-thirds of facilities on federal watch list received high ratings. The reason: the system requires self-reporting of data used to determine a nursing home’s rating – data that Medicare does not verify before issuing a final rating. The star rating system does not take into account state data of violations or complaints, which is the level that most violations are reported.

With such a microscope focused on the five-star system, there is likely to be a huge push to reform the rating system. Consumers should not rely on the Medicare rating system when determining which nursing home is best for a loved one. When evaluating a nursing home, it is recommended that a family look at the facility, talk to other residents when possible, and look at state reports about operational or health code violations.

Certified Medicaid Planners™ are often very helpful in assisting their clients with nursing home placement. As an experienced long-term care planner, a CMP™ will have a plethora of anecdotal evidence of past clients’ experiences in local facilities.

Patients often do not get to choose their initial nursing home. Hospital discharge units are forced to place patients in the first beds available at the time of discharge. That leaves the family facing a facility that may or may not be in the best interest of the patient overall. Most people think that a Medicaid patient has no choice in facilities; however, a Medicaid patient can transition from one facility to another provided that the new facility accepts Medicaid. A CMP™ can help families get a patient on a waiting list and transition the patient to a better facility.

For more information on how to find a CMP™ in your area, click here.

[1] New York Times, August 24, 2014: “Medicare Star Ratings Allow Nursing Homes to Game the System”

As the premier standard-setting body in the Medicaid Planning field, the CMP™ Governing Board established an ethics panel made up of professional Medicaid Planners.

CMP™ Governing Board
24600 Center Ridge Road, Ste. 270
Westlake, OH 44105
Phone: (844) 314-7851
Fax: (216) 220-1541

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