Consumer Alert: Exposing the Flaws in Medicare’s 5 Star Rating System of Nursing Homes

Please Share

The Centers for Medicare and Medicaid Services (CMS) recently began a new rating system to help consumers compare nursing homes. It adds an additional feature to the Nursing Home Compare component on Medicare, rating nursing homes that receive Medicare or Medicaid funds according to five criteria, giving each one “stars” to indicate high or low ratings. A one-star facility would be much below average, while five stars designate far above average. It is not surprising that with a governmental rating project in a bureaucracy this large, various shortcomings exist.

Problems with the 5-Star Rating System

Even the Medicare Web site points out that the data for the 5-star rating system is limited. In giving a nursing home a rating, the rating system considers Medicare’s health inspection reports, the facility’s staffing, and ten nationally standardized quality measures in providing its ratings to the public. CMS acknowledges that there are differences in state licensing requirements from state to state that affect quality. The five-star rating system is only appropriate to compare nursing homes within the same state. Health inspection reports, therefore, do not provide a reliable way to see if one nursing home is better than another, if a state line happens to be between them.

Staffing is another basis for CMS’s rating system, and staffing is self-reported by the facility. What’s to keep a facility from providing incorrect information to CMS to make itself look better? Nothing we can determine. Staffing data are reported just once a year and reflect staffing over a two-week period only. That report, which becomes public information, could be wildly inaccurate in describing average staffing levels over a year’s time. We consider this to be the worst defect in the rating system, and potentially the most dangerous if a consumer relies on it.

Another weakness of the five-star rating system is that the quality measures are also self-reported by the nursing homes. In addition, the rating system does not measure all of the critical aspects of safety that the family of an elder entering a nursing home should know. It focus instead on a few aspects of care at a most basic level, like eating and dressing, and does not provide any information about how often things go wrong with these measures.

Why These Flaws Are Fatal

From a legal point of view, one of the glaring weaknesses of every government rating system is that consumers have no way of knowing how often or whether the nursing home has been sued for neglect or abuse of its residents. We have no national database to record how many civil lawsuits have been filed against nursing homes, and to describe which homes have lost lawsuits that went to trial. There is, of course, some relationship between below-average nursing homes and citations those facilities receive from CMS for failure to properly deliver care, or meet other requirements, but this is not at all a clear indicator of how bad things could be. Facilities often fight citations through the hearing process CMS makes available, and the degree of the violation for which a facility was cited by CMS can end up being reduced before the public even learns of it. It can be deceiving, making a citation for poor care appear to the public as if it is not as bad as CMS originally found it to be. The public record of a citation against a nursing home is neither the whole story of what happened nor of how extensive the violation was.

How to Get More Accurate Information on Nursing Homes

What’s the takeaway message here? Consumers who are searching for a nursing home should plan to spend as much time as they can investigating all sources of information about the nursing homes they are considering. The Medicare Web site alone is not reliable enough for access to complete information. Newer nursing homes and poor quality homes which have had a change of name or ownership within the fifteen months prior to the implementation of the 5-star rating system do not even show up in Medicare’s ratings. No rating information will be stored on the Medicare site for those nursing homes which have changed names and had to apply for recertification by Medicare because of the name change. Go to your state’s Medicaid Web site to investigate as much as you can find before making your choice.

For more information from a lawyer’s view on using the Internet and other resources wisely to help you choose a nursing home, see Carolyn’s mini-book, The Boomer’s Guide To Aging Parents, Vol. 4, How to Choose A Nursing Home, available at

Tiny URL for this post:

Please Share
JUST RELEASED “The Family Guide To Aging Parents”
Stack Of CashCheck out our latest website: click HERE to learn more
FREE Report: “One Critical Step You Must Take To Avoid Your Aging Parents Debts”
CLICK on the image Below
Testimonials by our readers
"Thank you for the article on the "grey area". It validated what I am currently going through with my Mother. It is so painful for me to go back and forth with her behavior. I just don't know what to do about the estranged sister who has exploited well over $50K of my mother's savings and my Mothers admitted " lack of "will power" to say no to her." Robert ________________________________ "I do want to thank you for the Webinar you offered. It helped me a great deal as I was facing the need to lead our family in finding a safe living situation for our mother. That information and the other information you offered as downloads gave me much needed guidance when I was feeling tremendous anxiety and uncertainty." Betty
FREE Report: 10 Warning Signs Your Aging Parent Needs Help With Money
Get Quick Tips – Newsletter FREE…. Just CLICK Below
  • What To Do When Your Aging Parent Is No Longer Safe Living Alone But Refuses To Move July 11, 2019
    What To Do When Your Aging Parent Is No Longer Safe Living Alone But Refuses To Move Carolyn Rosenblatt, RN, Elder law attorney, “My mom is not safe by herself but she refuses help!” “My dad can’t manage alone…Read more ›
    Carolyn Rosenblatt
  • Here’s The Newest Utility Bill Scam May 30, 2019
    Carolyn Rosenblatt, RN, Elder law attorney, We live in a county with a high number of older residents. A neighbor recently alerted all in our area to yet another scam she had encountered, targeting the unsuspecting. Here’s how it…Read more ›
    Carolyn Rosenblatt
  • A Remedy For Isolated Aging Parents April 30, 2019
    By Carolyn Rosenblatt, RN, Attorney, The U.S. Census Bureau projects that by 2060, nearly twenty-five percent of Americans will be age 65 and above.  At the same point, the number of people age 85 and older will triple. What will they…Read more ›
    Carolyn Rosenblatt
  • Warn Your Aging Parents About Fake “Social Security” Calls–They’re Scams April 10, 2019
    Carolyn L. Rosenblatt, RN, Elder law attorney, Scams targeting our aging loved ones never seem to stop. Thieves can fool the recipient of a call by showing a “real” number on caller ID with spoofing computer software. That’s a…Read more ›
    Mikol Davis
FREE Report: Mental Wellness Technique For Stress Relief