Rating changes drop nursing-home quality scores

A major update to a national rating system for nursing homes has had a trickledown effect on the ratings of Pennsylvania facilities, one that could affect their ability to attract residents.

Late last month, 220 Pennsylvania nursing homes slipped in their rankings under what is known as the Nursing Home Compare Tool, compiled by the Centers for Medicare and Medicaid Services, a federal agency that oversees the Medicare program and helps states administer Medicaid.

The declines were not the fault of the nursing homes, but instead a symptom of what may be the largest update to the comparison tool since it was created in 2012.

The Centers for Medicare and Medicaid Services, or CMS, ranks nursing homes based on staffing levels, health inspections and quality of care. Nursing homes get between one and five stars, with the rating made public on CMS’ website and used by consumers, providers and hospitals to find the best nursing homes in a region.

A CMS spokesperson said the department continues to make changes to the five-star rating system in an effort to incentivize facilities to continue to improve the quality of care they offer.

“In order to continue to improve quality, we need to constantly evaluate and enhance our expectations, so that facilities continue to strive to achieve better performance and higher ratings, thereby improving quality and outcomes for residents,” said the spokesperson, who wished to remain anonymous.

To alert consumers of the change, CMS has emphasized the update on the Nursing Home Compare website and has alerted other agencies that work with seniors looking for care.

Critics, however, said the most recent update could still confuse consumers, who may not understand that a nursing home dropped in rating not because of a change in quality but because the goalposts were moved.

“These changes would indicate that 33 percent of Pennsylvania nursing homes became worse overnight,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, a Harrisburg-based group representing providers of senior care. “The data tells a different story: Nursing homes have made significant improvements in quality of care and staff have never been more dedicated to their residents.”

Consumers themselves have been quiet over the change, according to Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care, a consumer advocacy group in Washington, D.C.

That silence could mean they have not noticed the changes, according to Grant.

“My sense is that consumers research the ratings of a facility at the time they are looking for a facility, but don’t necessarily go back after that and would, therefore, not see that the ratings had changed,” she said.

Nonetheless, the group supports updates to the rating system as a way to ensure the ratings remain helpful to consumers, she said.

The ratings slide has been a nationwide problem, with a third of the county’s nursing homes losing a star overnight, according to Lori Mayer, vice president of investor relations, brand management and marketing communications at Genesis HealthCare, a senior care provider based in California. The company operates homes in the Philadelphia area as well as the Hamilton Arms Center senior home in Lancaster Township, Lancaster County.

“We are disappointed that recent changes to the Five-Star Rating System by CMS have resulted in many centers receiving a lower star rating — even though nothing has changed in terms of the quality of care provided,” Mayer said. “That’s confusing for families and residents who need simple, clear information.”

Changes to the CMS rating system included enacting separate measures for short-term and long-term residents, rather than one rating for both. CMS also reduced the number of days that a facility’s registered nurse can be off the premises.

In addition, the agency tweaked its formula for awarding stars, making it harder for nursing homes to earn the same number as before. The changes are based on overall quality improvements at nursing homes nationwide.

The last tweak was in 2015. But going forward, the agency will make changes every six months, steadily raising the bar for nursing homes so they show consistent improvement, according to the CMS spokesperson.

The ratings are an important tool for senior homes and have an effect on many facets of senior care, including contracts with insurance companies and recommendations from hospitals. Shamberg said that the associations’ members fear the ratings change could cause insurers and hospitals to refer patients to other facilities with better ratings.

“For our membership this is worrisome and can have a real effect on their ability to admit residents,” he said.

CMS said the website for the rating system also contains inspection reports for each facility. The agency noted that hospitals and insurers should review the reports to see if a rating change was the result of an inspection or an update to the system.

Crafting a system to accurately rate the quality of nursing homes is challenging, according to Douglas Motter, president of East Hempfield Township-based Homestead Village, a senior living facility with 495 residents and five stars on Nursing Home Compare.

Motter said that while five-star ratings are usually indicative of a high-quality home, minor problems in a facility’s annual inspection or changes to the system can keep a quality facility at three stars.

The ratings also don’t take into account the experiences of consumers, according to Motter.

“The challenge is that the consumers don’t have a voice,” he said. “It’s based on annual inspection and self-reported data. It doesn’t measure the taste of food, how caring the staff is or friendliness of the home.”