Key Elements Used In Determining the Quality of Care in Nursing Homes: What to Look For

Written by Adam Peck Category: Elder Law January 26th, 2013 6 min read

Quality of Care in Nursing Homes – Key terms

Overall rating One (worst) to five (best) stars, determined by the federal Centers for Medicare and Medicaid Services based on data in three elements:

health inspections,

nurse staffing, and

measures of quality of care.

Total stars

One (worst) to 15 (best). CMS gives homes one to five stars in each of the three elements above. The total of all three elements is part of the U.S. News rankings process. The rest involves star ratings in the individual categories.

Health inspections

Conducted by state inspectors at least every 15 months to determine compliance with Medicare and Medicaid standards for food safety, hiring practices, and other aspects of running a nursing home. Homes get one to five stars based on the three most recent regular inspections plus any complaint-related inspections in the past three years.

Nurse staffing

Homes get one to five stars based on average time per patient spent by registered nurses, licensed practical nurses, licensed vocational nurses, and certified nursing assistants. Calculation reflects hours worked during two-week period before most-recent regular health inspection divided by number of residents, adjusted by residents’ needs and health status.

Quality measures

Homes get one to five stars depending on the most recent three quarters of data reported by homes on percentages of residents who received certain care, such as flu vaccinations, and who had care-related problems such as pain, bedsores, or urinary tract infections. Nineteen measures are displayed. Star ratings were determined by 10 with especially high reliability.

Individual nursing home details

Medicare/Medicaid participation Most nursing homes accept Medicare, which pays all or part of the cost of a stay following hospitalization of at least three days; coverage is limited to 100 days per hospitalization. Medicaid covers a stay of any length for individuals who meet income requirements and are ineligible for or have exhausted their Medicare benefits.

Number of beds How many beds are certified for Medicare and/or Medicaid residents. Private-pay beds are not included.

Ownership Nursing homes can be owned by for-profit corporations, nonprofit groups, religious bodies, and other types of organizations. Initial certification Date home was certified as meeting Medicare or Medicaid requirements. Date when state licensed home to operate is different.

Continuing-care retirement community Provides spectrum of care that changes over time according to resident’s needs, from independent apartment living to assisted living to full-time nursing-home care. Generally costly, with a large upfront payment in addition to monthly fees.

Part of a chain Two or more homes under one owner or operator.

Special-Focus Facility (SFF) A nursing home with a persistently bad or erratic history of care. It will be monitored and reinspected until it either has improved enough to be taken off the SFF list or it loses its Medicare or Medicaid certification.

Health inspection details

Health inspections Conducted by state inspectors at least every 15 months to determine compliance with Medicare and Medicaid standards for food safety, hiring practices, and other aspects of running a nursing home. Homes get one to five stars based on the three most recent regular inspections plus any complaint-related inspections in the past three years.

Health deficiencies Specific health or safety requirements the nursing home failed to meet in an inspection.

Complaint investigations Conducted based on complaint from family, friends, or others to state survey agency.

Inspection date When regular or complaint-related inspection was conducted.

Severity of health deficiency Indicates degree of seriousness. 1=did not harm but posed a threat of minor harm; 2=did not harm but posed a threat of more than minor harm; 3=caused harm but did not immediately put residents in jeopardy; 4=immediately threatened health or safety.

Scope of health deficiency Relative number of residents who were or could have been affected. 1=few or none; 2=some; 3=many.

Nurse staffing details

Nurse staffing Homes get one to five stars based on average time per patient spent by registered nurses, licensed practical nurses, licensed vocational nurses, and certified nursing assistants. Calculation reflects hours worked during two-week period before most-recent regular health inspection divided by number of residents, adjusted by residents’ needs and health status.

Hours per resident (all nurses) Average care time per resident per day spent by registered nurses, licensed practical nurses, and licensed vocational nurses, reflecting hours worked during two weeks before most-recent regular health inspection. Adjusted by residents’ health status and condition.
Hours per resident (RNs only) Average care time per resident per day spent by registered nurses, reflecting hours worked during two weeks before most-recent regular health inspection. Adjusted by residents’ health status and condition.

Hours per resident (LPNs, LVNs) Average care time per resident per day spent by licensed practical nurses and licensed vocational nurses, reflecting hours worked during two weeks before most-recent regular health inspection. Adjusted by residents’ health status and condition.

Hours per resident (CNAs) Average care time per resident per day spent by certified nurse assistants, reflecting hours worked during two weeks before most-recent regular health inspection. Adjusted by residents’ health status and condition.

Quality measure details

Quality measures Homes get one to five stars depending on the most recent three quarters of data reported by homes on percentages of residents who received certain care, such as flu vaccinations, and who had care-related problems such as pain, bedsores, and urinary tract infections. Ten of the 19 displayed measures determined the star rating. Indicates adequacy of care such as percentages of residents with pain, bedsores, or urinary tract infections. From data nursing homes are required to collect and report for each resident. The star rating is based on 10 of the 19 measures shown.

Long-stay measures Apply to residents who are in a home for longer than a few days or weeks.

Short-stay measures Apply to residents who are in a home for a brief period to recuperate or to receive rehabilitative services.

Fire safety details

Fire safety Medicare– and Medicaid-certified nursing homes must meet safety standards set by the National Fire Protection Agency.

Fire safety deficiencies Ways in which nursing home failed one or more NFPA standards in the most recent inspection.

Severity of fire deficiency Indicates seriousness of failure. 1=did not harm but posed a threat of minor harm; 2=did not harm but posed a threat of more than minor harm; 3=caused harm but did not immediately put residents in jeopardy; 4=immediately jeopardized health or safety.

Scope of fire deficiency Relative number of residents who were or could have been affected. 1=few or none; 2=some; 3=many.

– from Steven Peck, Senior Attorney at Peck Law Group

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Written by Adam Peck

Expertise: Personal Injury

Adam J. Peck, ESQ is a principal with Peck Law Group, APC. In 2008, Mr. Adam Peck received his Juris Doctorate from Whittier Law School where he graduated Cum Laude. His practice is primarily dedicated to representing Elders, Dependent Adults, along with their loved ones and family members, who have suffered horrific personal injuries.