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How to Balance the CMS 5-Star Quality Rating System in your Skilled Nursing Center Selection Process

Posted by SALMON Health on | No Comments

Selecting a skilled nursing center for you or your loved one can be a daunting process to navigate. In addition to simply selecting a home, when you are choosing a community to live in you are also selecting the care,services, employees, activities, amenities and other residents that accompany it. Learning about all the facets of several skilled nursing centers you are considering in order to make the right choice can be time-consuming and confusing. Fortunately, there are several tools available to aid you in the decision making process.

CMS 5-Star Quality Rating System:

One of the most popular resources to help in selecting a skilled nursing center is the Center for Medicare & Medicaid Services (CMS) 5-Star Quality Rating System.

CMS, which is a branch of the U.S. Department of Health and Human Services, evaluates skilled nursing centers quarterly using a detailed evaluation system that examines factors such as health surveys, quality measures and staffing to aid consumers in comparing and selecting skilled nursing centers.

How the 5-Star System Works:

According to the CMS website:

The Nursing Home Compare website features a quality rating system that gives each nursing home a rating of between 1 and 5 stars.  Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.  There is one Overall 5-star rating for each nursing home, based on a separate rating for each of the following three sources of information:

Health Inspections – The health inspection rating contains the three most recent health inspections and investigations due to complaints.  This information is gathered by trained, objective inspectors who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met CMS’s minimum quality requirements. The most recent survey findings are weighted more than the prior year.

Staffing – The staffing rating has information about the number of hours of care provided on average to each resident each day by nursing staff.  This rating considers differences in the levels of residents' care need in each nursing home.  For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.

Quality Measures (QMs) – The quality measure rating has information on 15 different physical and clinical measures for nursing home residents.   The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.

Weighing the 5-Star System alongside Other Factors:

While the 5-Star Quality Rating System is a useful tool to evaluate skilled nursing centers, it is important to remember no rating system can address all of the important factors to consider when choosing which nursing home is best for a particular person.

Rather than using the system as a determining factor, you should use it as a tool to identify areas you may want to ask questions about. For example, if a community you are interested in has a deficiency in a certain area, you can make it a priority to ask why they may have been rated a certain way. Healthcare is a complex industry, and not every situation can be represented through numbers and statistics.

Other Considerations to Make During the Selection Process:

Specialized services: If you or your loved one requires specialty care such as complex rehabilitation or memory care, you will want to prioritize a community offering those services. A community able to provide the specialized care you need will be more likely to yield long-term positive results than a community lacking those services – regardless of their ratings.

Care plans: Since each resident will need an individualized care plan, you may want to obtain details about how care plans are determined, how often they are reviewed and changed, the protocol for handling issues which may arise, etc.

Location: When selecting a skilled nursing center, close proximity to family members may be a significant factor. Nursing home residents who visit with family frequently are more likely to feel happier and have a better quality of life. Therefore, selecting a nursing home closer to family may be wiser than choosing one further away, even if it has a lower rating.

Environment: A skilled nursing center will become home for you or your loved one, so you’ll of course want it to feel like home. Set up a tour and confirm the environment is clean and makes you or your loved feel welcome and comfortable.

Staff: In order to ensure proper attention and care, you’ll want to check the staff-to-resident ratio during each shift. More importantly, you’ll want to meet and observe some of the staff to be certain they are positive and friendly.

Activities and amenities: Since you or your loved one will be spending the majority of their time in the skilled nursing center you select, you’ll want to make sure there are dynamic amenities to keep residents active and entertained.  

Meals: If food is an important factor for you or you’ll loved one, you may want to ask about the quality and variety of foods the skilled nursing center provides. You may also want to know the process around serving meals, such as where and what time the residents can eat, and how the kitchen handles dietary restrictions.

Every person seeking nursing home care is unique, so each person will have a different balance of what factors are most important to them when choosing a community to live in. By prioritizing what is most important to you, researching and touring communities, asking the right questions, and considering tools such as the CMS 5-Star Quality Rating System, you should be equipped to make an informed decision about which community best fits your needs.