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Senior Care Research: How to Use the 5-Star CMS Rating to Understand the Quality of Care at a Community

A senior woman sits on a couch and listens to another woman talking

Providing quality care requires expertise, high standards and dedication. A high rating from the Centers for Medicare & Medicaid Services is clear proof that the level of care offered at a senior care community is top-tier in the industry. But to truly appreciate a CMS 5-star rating, it helps to understand how the rating is determined.

 

A CMS 5-Star Rating Matters to a Lot of People

 

Residents and Families

Future residents and their families look for a high nursing home star rating as proof that the health care they’ll receive at a community will be high caliber. Current residents and families like to know the community’s standards have remained high, and they can feel secure if they need more health care extensive support.

 

Staff Members

Talented nursing professionals want to work with the best, and a CMS 5-star rating means they’ll join a team that holds high senior care standards and an environment and culture that provides opportunities to grow their skills. If you see a 5-star rating, you can feel confident that dedicated team members will work there, now and in the future.

 

Discharge Planners, Social Workers, Physicians

When referring patients, medical professionals rely on reports from third-party experts like the Center for Medicare and Medicaid Services to recommend communities that can provide the quality health care you need.

 

Insurance Companies, Accountable Care Organizations and Bundled Payment Providers

Seniors are more frequently receiving referrals through these group organizations, and as a rule, they only recommend communities rated three stars or above by CMS.

 

How Is a 5-Star Rating Calculated?

 

If you’re looking for a senior living community that provides quality care, but you don’t have a medical background, a jargon-free explanation of the excellence behind a CMS nursing home star rating can strengthen your confidence in the care you’ll receive at a community with the distinction. It’s an intricate calculation, so we’ve broken it down into the distinct components.

Three components that make up a CMS 5-star rating: The health inspections, quality measures and staffing standards.

 

Health Inspections

To find this portion of the rating, scores from state-conducted health inspections are combined with a deficiency rating and the number of substantiated complaints. The scores of all senior care facilities in the state are then graded on a curve. The top 10% receive 5-star ratings. The bottom 20% receive 1-star ratings. The middle 70% are divided into three sections of 23.33% and awarded 2-star, 3-star and 4-star ratings based on their scores.

 

Quality Measures

CMS uses ten quality measures to rate this portion of their overall score. These quality measures include seven long-term (chronic) categories and three short-term (post-acute) categories.

Long-Term Care Quality Measures:

  • Activities of Daily Living (ADL) Decline (Is a long-term care resident’s ability to conduct fundamental self-care tasks worsening?)
  • Mobility Decline (To what extent is a long-term care resident less active and mobile than when they started their stay?)
  • Catheter (What percentage of long-term care residents require the use of a catheter?)
  • High-Risk Pressure Ulcers (How many long-term care residents have experienced this type of injury?)
  • Physical Restraints (Has the community had to confine long-term care residents?)
  • Urinary Tract Infections (How many long-term care residents have experienced UTIs during their care at the community?)
  • Moderate to severe pain (Have long-term care residents reported high levels of pain?)

Short-Term Care Quality Measures:

  • Pressure Ulcers (How many short-term care residents have experienced this type of injury?)
  • Moderate to Severe Pain (Have short-term care residents reported high levels of pain?)
  • Delirium (To what extent have short-term care residents experienced an acutely disturbed state of mind?)

The reports of ADL decline and mobility decline are the most heavily weighted in the score (1.667 times the others). The total quality measures score is then calculated on a nationwide curve among senior care facilities. The top 10% receive 5-star ratings. The bottom 20% receive 1-star ratings. The middle 70% are divided into three sections of 23.33% and awarded 2-star, 3-star and 4-star ratings based on their scores.

 

Staffing Standards

This component specifically records the quantity and availability of the nursing staff. Other community team members, while important, aren’t measured here. CMS measures how many hours registered nurses spend with each resident each day, as well as how many hours the total nursing staff — registered nurses, licensed practical nurses and nurse aides — spend with each resident each day. A senior care facility must meet or exceed the CMS staffing study thresholds (the staffing level CMS deems sufficient) to receive a 5-star rating.

 

Achieving a CMS 5-star rating is an impressive feat, and it’s a metric that matters to many seniors and their families when searching for a senior living community. Ask a community about their CMS rating to help ensure the health care you or your loved one can expect will be exemplary.