Reimagining Five Stars

October 14, 2014
Virgil Thomas,

01How would you change the nursing home five-star rating system? Last week you may have heard of the new Medicare revisions; The New York Times provided some great coverage.

The five-star rating system has become the gold standard for evaluating the nation’s more than 15,000 nursing homes since it was put in place five years ago, even though two of the major criteria used to rate the facilities — staffing levels and quality statistics — are reported by the nursing homes themselves and generally are not audited by the federal government.

On Monday, officials said they would make several changes, starting in January, aimed at addressing some of these concerns.

Nursing homes will have to begin reporting their staffing levels quarterly using an electronic system that can be verified with payroll data. And officials will initiate a nationwide auditing program aimed at checking whether the so-called quality measures rating — which is based on information collected about every patient — is accurate.

Beginning in January, nursing homes’ ratings will also be based partly on the percentage of its residents being given antipsychotic drugs.

In August, The New York Times reported that the rating system relied so heavily on unverified and incomplete information that even homes with a documented history of quality problems were earning top ratings. The number of homes with above-average ratings has increased significantly since the program began: In 2009, 37 percent of homes received four- or five-star ratings. By 2013, nearly half did.

Quality of care and quality of life can be extremely difficult to measure. This is not made any easier by the self-reporting inherent in the current system. These changes will go a long way towards making the mechanism more reliable. Also, adding certain indicators like antipsychotic usage and hospital readmissions make the system more valid.


We are very interested in what our readers think. Let’s assume for a moment that the book is open for a little while longer. What would you change about the system, what indicators would you add, is the system even able to truly assess quality of life let alone quality of care? Leave us a comment and send to your friends.

2 Comments. Leave new

I’d like to see a measure that assessed the empowerment of Elders and their care partners to shape the rhythm of daily life. Wouldn’t it be great to know that if you had to choose a long-term care community it was one that ascribed to a philosophy of life that ensured each individual living there was honored, regardless of life challenges? And that is measured and reported, not just talked about in the marketing language. How could that be done?


I would like to see a model where the Elders are seen/treated or even contracted as the “true experts” (to quote Dr. Al Power). A model that truly turns the managing of faciltities up-side down, where staff employment is done by and through the Elders, and everything is measured through the Eden “domains of wellbeing”.


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