Medicare star ratings shown on Caring.com nursing home and home health agency listings come from data provided by the Centers for Medicare & Medicaid Services. These ratings are designed to provide you with an objective view of nursing homes and home health agencies that receive Medicare funds.
|Well above average|
|Well below average|
How Nursing Home Medicare Star Ratings Are Determined
Medicare uses data from three years of on-site inspections and evaluations to assess the health inspection portion of a facility’s overall star rating. These evaluations include both standard surveys and complaint surveys. The process involves an inspector visiting the site and documenting conditions there, with more than 180,000 visits of this type each year. When weighing the information gathered, the inspector considers inspections from all three years, with an emphasis on the most recent evaluation.
Inspectors also measure the amount of contact time residents have with the staff members who see to their care. Medicare then compares that data from patients with similar needs in similar facilities. That way, nursing homes serving residents with less intense needs are not penalized for having a smaller staff than facilities whose residents need more care.
Nursing homes gather and report information on 11 quality measurements that help give an idea of residents’ health and level of care. Those quality measurements include important factors like how often antipsychotic medications are used for short and long-term care patients, physical health measurements, and other vital pieces of data that help to demonstrate the facility is providing the necessary care for residents.
How Home Health Medicare Star Ratings Are Determined
Quality of Patient Care
Medicare uses patient assessment data provided by home health agencies and Medicare claims to evaluate the quality of patient care provided by these agencies. Specifically, it looks at 9 quality measurements that evaluate how often agencies provide recommended care like drug education and flu vaccines and how often patients got better at managing daily activities and pain.
Patient Experience of Care
Home health agencies regularly survey eligible patients via mail and/or phone and submit these results to Medicare. The standardized Home Health Consumer Assessment of Healthcare Providers and Systems Survey evaluates patients’ satisfaction with different aspects of their care and the communication with the agency. Medicare then combines scores from relevant questions to create the overall summary rating.
Keep in Mind
There are a lot of insights to be gained by looking into the five-star system, but there are also some limitations that should be taken into account before making a decision about anyone’s care. Here are a few of the most important considerations for nursing home ratings:
- Staffing is self-reported by the facility, which means there’s less accountability when it comes to maintaining accurate measurements of actual resident experiences on a daily basis.
- Similarly, the data on health quality measurements is self-recorded. This is easier to verify in inspection, but it does provide the opportunity for inaccuracies.
- Star ratings are only comparable within a state’s borders. That’s because the calculations that determine the basic three-star rating are built with each state’s data, so a four-star rating in one state might perform like a three-star rating in another state.
Medicare star ratings are a great source of information for a certain set of metrics describing nursing homes and home health agencies in your state. But they’re certainly not the only source of information, nor are they even the only source for quantitative information. The ratings can provide a rough guideline that helps you prioritize your research, but hands-on experience, reading from other sources, and other research are also key steps to take before choosing the right care provider for your loved one.