Nursing Home Compare Updates Star Criteria

Choosing a Nursing Home? Start with Nursing Home Compare.

Choose carefully. The Nursing Home Compare site can give you a start in evaluating care in nursing homes. It should be your first stop but one of many sources you use to evaluate care. @Stockbyte, Getty Images

The Compare sites are the official Centers for Medicare and Medicaid (CMS) sources for information about the quality of health care providers, and the Five-star rating system is just one of many ways they’re working to make quality information easier to understand and compare. These ratings are based on established scientific standards of rigor and accuracy. 42% of people don't know nursing home rating system exists.

Nursing Home Compare uses star ratings to help consumers compare nursing homes and choose one based on quality. It contains quality of care information on every Medicare and Medicaid-certified nursing home in the country, including over 15,000 nationwide.

These ratings include:

  • Performance on health inspections, quality measures, and hours of care provided per resident by staff.
  • Health and fire-safety inspections.
  • Nursing home staffing information about the number of registered nurses, licensed practical or vocational nurses, physical therapists and nursing assistants in each nursing home.
  • A set of quality measures including percent of residents with pressure sore, percent of residents with urinary incontinence and more.
  • Penalties against a nursing home.

The Nursing Home Compare site recently changed some of its criteria. Since the new rules went into effect, nearly a third of nursing homes have been marked down on their overall grade while two-thirds lost points on individual measures. It does not necessarily mean that the nursing home is worse than it was, only that the standards of quality it needs to meet has increased along with the rigor of how to report them. Here is a summary.

  • Add 2 Quality Measures (QMs): for antipsychotic medication use in nursing homes to the 5- Star calculations.  One measure is for short-stay residents and a second measure reflects continued use of such medications for long-stay nursing home residents.
  • Raise Performance Expectations: by raising the standards for nursing homes to achieve a high rating on all publicly reported measures in the Quality Measures category.
  • Adjust Staffing Algorithms: to more accurately reflect staffing levels. This was previously a self-reported number by nursing homes.
  • Expand Targeted Surveys: a plan for State Survey Agencies to conduct specialized, onsite surveys of a sample of nursing homes across the U.S. that assess adequacy of resident assessments and the accuracy of information reported to CMS that is used in calculating quality measures used in the rating system.

Here are some other tips for choosing care:

Consider employing the services of a geriatric care manager. Care managers evaluate a senior's situation with regard to health needs, housing choices and financial needs.

A Care Manager finds out what you can do yourself, what can be done by other family members, matches this to a care plan and the economic situation and arranges for and monitors services.

Before you ever step in the door for a nursing home tour, consider the following steps.

  • “Google” the facility and see what you find online. Go to their web site as well but take it with a grain of salt.
  • Go to blog portals such as and and type “nursing home” into the search. (Or assisted living, whatever you are searching for…) Find out what bloggers are saying.
  • Find out who the owners are. Is this a for-profit or not for profit organization? Is it family owned or corporate run? Who are the investors? What are their motives? Dig a little and find out. Do these people / corporations have a history in long-term care? How long have they owned the particular facility? Has often has the facility changed ownership hands? Is it for sale currently? Has the firm divided into smaller corporations insulating it from liability? That is a big red flag. Read this excellent article in The New York Times and then make your own decisions.
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