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LTC providers speak out on Five-Star Quality Rating System

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Last month I blogged about the Centers for Medicare & Medicaid Services’ controversial Five-Star Quality Rating System in light of news of its revamped Nursing Home Compare website. I invited readers to share their thoughts on the rating system and the website, knowing that this was one issue certain to generate some commentary. And it sure did.

The responses overwhelmingly expressed frustration and criticism of the rating system. Below is some of the feedback I received. Want to join the conversation? Write me at  

“As a nursing home administrator, I am very upset by this rating system. We are a not-for-profit 83-bed skilled nursing facility. We admit the residents that no other facility will take. I think it would be more accurate to compare apples to apples instead of apples to oranges. Our facility provides a higher level of care than those in our service area. Most of the other facilities in our service area have a higher star rating but will not admit residents that require enteral feedings, tracheostomy care, wound care or intravenous medications. In other words, they do not take residents that require higher levels of care. We get referrals from as far as three hours away because we do have a two-star rating when other nursing homes in our service area have 4-5 stars. Maybe if they go into more detail regarding the acuity level of the different homes. Some homes may call themselves skilled but only provide intermediate care.

“Just to be clear, I do not have a problem with other homes that have a higher star rating. I just feel like it is a skewed comparison. I would also love to see more resident-centered care measures on there. How about if the resident gets to wake up whenever they want and go to bed whenever they want? Do they have more liberalized menus? Have they embraced the culture change movement? Those can be just as important quality measures as the others listed.” –Angie Simmons, administrator

“Five-star is NOT objective. Using their point system, a facility with a large number of “D” citations can come out a one-star, whereas one with only one serious citation can be a two-star or more.” –Paul Konstam, administrator

“I have visited other nursing homes in other states and felt that the survey processes state to state are not the same. I have found infractions in other states that Arkansas surveyors would write. Also, on the data some nursing homes residents are sicker than others; physician practices differ from area to area; and hospitals discharge differently. I am not thoroughly convinced on the data as a method of comparison." –Judy Belcher, administrator


Patricia Sheehan

Patricia Sheehan


Patricia Sheehan wrote for Long-Term Living when she was editor-in-chief. She left that...



Just sharing...This rating is based on the information that the CMS receives from our MDS (Minimum Data Set), what our MDS nurses inputs. We analized how this is done and pretty much this reflects the newly updated 30 pages of MDS.
Our star rating recently went down from a 4 to a 3 and the explaination indicated what happened in the facility on the period indicated ie: 3rd and 4th quarter of 2011.
It was our increase in pressure ulcer and UTI rates. Our sister company's star rating on the other hand increased, it was because the pressure ulcer rate went down, their Quality Measures improved from a 1 to a 2.
For those who are wondering, check your MDS out and maybe you will know how to improve your star rating. Right now we are in the process of implementing measures to decrease our PU and UTI rates. Thank you.