Strengths and limitations
The 5-star rating system has strengths and limitations. Here are some things to consider as you compare nursing homes.
Health inspection results
- Comprehensive: The nursing home health inspection process looks at all major aspects of care in a nursing home (about 180 different items).
- Onsite visits by trained inspectors: This is the only source of information that comes from a trained team of objective surveyors (inspectors) who visit each nursing home to check on the quality of care, inspect medical records, and talk with residents about their care.
- Federal quality checks: Federal inspectors check on the state inspectors' work to make sure they're following the national process and that any differences between states stay within reasonable bounds.
- Variation among states: There are some differences in how different states carry out the inspection process, even though the standards are the same across the country.
- Medicaid program differences: There are also differences in state licensing requirements that affect quality, and in-state Medicaid programs that pay for much of the care in nursing homes.
Tip: The best comparisons are made by looking at nursing homes within the same state. You should be careful if you're trying to compare a nursing home in one state with a nursing home in another state.
- Overall staffing: The quality ratings look at the overall number of staff compared to the number of residents and how many of the staff are trained nurses.
- Adjusted for the population The ratings consider differences in how sick the nursing home residents are in each nursing home, since that will make a difference in how many staff are needed.
- Self-reported: The staffing data are self-reported by the nursing home, rather than collected and reported by an independent agency.
- Snap-shot in time: Staffing data are reported just once a year and reflect staffing over a 2 week period of time.
Tip: Quality is generally better in nursing homes that have more staff who work directly with residents. It's important to ask nursing homes about their staff levels, the qualifications of their staff, and the rate at which staff leave and are replaced.
- In-depth look: The quality measures provide an important in-depth look at how well each nursing home performs on important aspects of care. For example, these measures show how well the nursing home helps people keep their ability to dress and eat, or how well the nursing home prevents and treats skin ulcers.
- National measures: The quality measures we use in the 5-star rating are used in all nursing homes.
- Self-reported data: The quality measures are self-reported by the nursing home, rather than collected and reported by an independent agency.
- Just a few aspects of care: The quality measures represent only a few of the many aspects of care that may be important to you.
Tip: Talk to the nursing home staff about these quality measures and ask what else they're doing to improve the care they give their residents. Think about the things that are most important to you and ask about them, especially if there are no quality measures that focus on your main concerns.
View the technical manual containing additional information on the 5-star quality rating system - Opens in a new window.