Is That Really a Five-Star Nursing Home?

Consumers will be able to get more accurate ratings of nursing homes under a revised system that the federal government put into effect on Friday.

The change is a step toward ensuring that a five-star rating really means that the home provides exemplary service and is not simply inflating its scores by lying about its performance. Perhaps, not surprisingly, the overall ratings of nearly a third of the nation’s nursing homes dropped under the new rules.

The Centers for Medicare and Medicaid Services uses three main criteria — staffing levels, performance on certain quality measures, and annual inspections by state and federal inspectors — to rate homes from one to five stars over all and on each of the three categories separately. The results are posted on its Nursing Home Compare website. The old system relied heavily on self-reporting by the nursing homes of their staff-to-patient ratios and their quality measures. As The Times reported in August, even homes with a history of serious problems received high ratings based on their unverified self-evaluations.

The rule changes were aimed primarily at the recalibrating the quality-of-care measures, such as the percentage of patients with new or worsened pressure sores and the percentage of patients who report severe or moderate pain. The system still relies on self-evaluations of quality, but it raises the bar on an array of these measures, thus making it harder to get top ratings.

It also added new measures on the use of anti-psychotic drugs, reflecting concerns that some homes overmedicate patients to make them easier to manage. And it adjusts mathematical steps used to calculate staffing ratios. Before the change, about 80 percent of the nation’s nursing homes received a four- or five-star rating on their quality measures; afterward, about 49 percent did. The number receiving only one star for quality rose to 13 percent after the recalibration, from 8.5 percent. Two-thirds of the homes dropped stars from previous ratings.

Although the nursing homes will still be evaluating their own quality, the federal government will have state agencies conduct on-site surveys starting this year to check on the accuracy of quality statistics at a sample of homes across the nation. It is imperative that those surveys be as rigorous as possible to help determine if even stronger measures are needed.

Perhaps the most important improvement is that by the end of 2016, the government will require all nursing homes to report staffing levels — an important determinant of quality — every quarter, using an electronic system that can be verified with payroll data. That will be a far more objective measure than unverifiable self-reports.

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Is That Really a Five-Star Nursing Home?