5-Star Rating Systems Don’t Provide Information to Consumers About Skilled Nursing Safety

Finding the right nursing home for a parent or senior loved one requires a lot of research. Family members often rely on five-star rating systems to help them gauge the quality of a skilled nursing facility and whether it’s a contender that’s worth an in-person visit. However, these rating systems may not tell you anything about one of the most important quality of life factors: skilled nursing safety.5-Star Rating Systems Don't Provide Information to Consumers About Skilled Nursing Safety

A recent study published in the Journal of Health Affairs found that the five-star rating system from the Centers for Medicare & Medicaid Services (CMS) did not reveal the safety levels of the facilities.

Skilled Nursing Safety Measures

To determine the actual safety of residents at skilled nursing homes, the study’s authors, led by Daniel Brauner of the University of Chicago, looked at a few key measures:

When researchers compared the number of safety incidents to each facility’s score on the five-star system, it was clear that the rating system came up short.

The Ways That Skilled Nursing Safety Really Compares

As you would expect, the worst safety outcomes were at one-star facilities and the best safety outcomes were at five-star facilities. However, the star rating had no relationship to safety for the nursing homes with star ratings in-between, at three, four and five-star facilities.

“This lack of correlation makes skilled nursing interpretation more difficult for consumers, as the difference between a one-star and a two-star facility is quite different from the difference between a three-star and a four-star facility,” the researchers wrote.

In other words, for those choosing among middle-quality skilled nursing homes, the rating system doesn’t help find the safest home for their loved one. You can’t be sure if your loved one will be safer at a three-star or four-star nursing home, for instance.

The only exception to this finding was the medication error rate. Two, three and four-star ratings did seem to express the likelihood of medication errors, especially dramatic errors. Four-star rated nursing homes had a lower rate of medication errors than three-star and two-star facilities. Still, the researchers point out this is still a relatively weak correlation.

In the end, researchers concluded that the five-star system was indicative of whether a nursing home is among the very safest facilities, or among the worst.

“Part of the problem with looking at quality measures is, if you dig deeper, they’re very superficial in terms of: It’s either a yes or no,” Brauner told Skilled Nursing News. “They have it, or they don’t have it. It’s usually much more complicated.”

Further, Brauner argues that the broad idea of “quality” behind five-star systems is too large to reflect safety accurately.

Ways to Better Assess Skilled Nursing Safety for Your Loved One

What is the solution for those families who are comparing skilled nursing homes?

For family members to assess the real safety at these middling nursing homes, the researchers suggest a more in-depth rating system, that looks at measures of safety separately from overall nursing home quality.

Ultimately, it’s up to family members to dig into the statistics for themselves or find an expert who can perform that comparison for them.

As a starting point, NursingHomes.com’s review of each skilled nursing home offers a separate rating for nurses and records the number of incidents they’ve seen. Also, our Senior Care Advisors are here to help you to more closely evaluate the skilled nursing safety of the facilities you’re considering.

Have you gone through the process of evaluating skilled nursing safety for a parent or senior loved one? What was your experience like? We’d like to hear from you in the comments below.

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