Looking at Ratings from the State & Federal Government

It is useful to look at ratings provided by government agencies. The Federal Nursing Home Compare (NHC) and the Massachusetts Department of Public Health (DPH) MA Nursing Home Survey Performance Tool offer some nursing home rating options and other important data.

Some of the information is based on surveys.  It is important to know the vast majority of nursing homes are certified by Medicare and Medicaid which require inspectional surveys for recertification at least every 9 -15 months.  The Massachusetts DPH is responsible for doing these surveys in the Commonwealth.

In addition, the Centers for Medicare & Medicaid Services (CMS) The Special Focus (SFF) Initiative highlights nursing homes that are poor performers.

Before taking the ratings as “gospel,” a brief summary and a few things to consider are below.

Survey Interpretation Considerations

Surveys measure whether the nursing home meets certain “minimum” standards.  If a nursing home has no deficiencies, it means that it met the minimum standards at the time of the survey.  It is important to realize that surveys and ratings do not identify nursing homes that give outstanding care.  While reading the MA and Federal reports discussed below, keep in mind that the quality of a nursing home may get much better or much worse in a short period of time. These changes can occur when a nursing home’s administrator or ownership changes or when a nursing home’s finances suddenly change.

Survey inspectors are only in the nursing home for a few days which means surveys only provide a “snapshot” of what the facility is like – and the “snapshot” is usually taken when the facility administration and staff know they are being observed.  In addition, inspectors do not look at the care of all residents; they only look at a sample of residents.

A Medicare/Medicaid facility is required by law to make the latest survey report available for examination in a place readily accessible to residents, their families and legal representatives of residents.  The nursing home also must make available for the public for review, upon request: any surveys, certifications, and complaint investigations made during the 3 preceding years, and any plan of correction that the facility has put into effect.

Massachusetts DPH Nursing Home Survey Performance Tool

DPH developed the Nursing Home Survey Performance Tool that evaluates 132 items that have been reviewed during the last three surveys (44 selected items on each survey) and provides other facility data.  You can call the DPH at (617) 753-8000 to obtain survey information on facilities for which no results are available.

Medicare.gov Nursing Home Compare

CMS developed Nursing Home Compare (NHC), an information tool that uses a Five-Star Quality Rating System for nursing homes based on three sources of data: health inspections, staffing, and quality measures.

NHC is easy-to-use and provides a lot of information, but it should not be the only factor in your decision.  It is important to note:

  • NHC Staffing levels are reported by the nursing home itself and are not checked for accuracy.
  • The information is based on a two-week period prior to the time of a survey/inspection and does not tell you what staffing is like the rest of the time.

(In 2016, CMS initiated a quarterly electronic reporting system for facilities that is auditable back to payrolls to verify staffing information.  This new system will increase the accuracy and timeliness of data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing.  Public reporting of the new data is expected in 2018.)

Also, please note an important comment from an elder care expert:

“While Nursing Home Compare is the best resource for finding out about a facility’s quality and staffing, etc., deficiencies in the data undermine the reliability of the information provided.  For instance, the Quality Measures are self-reported by facilities and not audited by either the states or the Federal government.  In our experience, we have come across numerous facilities that have low staffing and many citations of substandard care, yet somehow have a four or five star rating in Quality Measures.”

Special Focus Facility (“SFF”) Initiative

The SFF Initiative is a CMS initiative to identify nursing homes that have a record of persistently poor survey performance which have been selected for more frequent inspections and monitoring.   The above link includes a listing of SFFI-designated nursing homes and an explanation of the program.

A Final Note on Ratings

Remember — Government agency reports represent “one piece of the puzzle” in your nursing home search.  Low ratings can tell more of a story than high ratings.  Consider ratings with your personal perceptions and other research to help you make an informed decision.

→ Next: Ombudsman Perspectives