Proof that the CMS Five-Star System is Junk!

By Steve Moran, Manager, Senior Housing Forum

Introduction: We are often called upon to assist our clients and their families in selecting a nursing home for rehab or long term caser. Traditionally we have learned not to place much confidence in the “rating” system of stars, currently so popular with nursing homes. Instead we focus on staff interaction with residents, compassion and grounding of leaders in the home, appearance of residents and evidence of caring staff and happy residents. The following article validates the importance of not relying so heavily on the “star” rating system.

Here, Steven Moran gathers the evidence to support the claim and offers some suggestions to assess the true quality of nursing homes

~ Regina McNamara

Back in February, US News and World Reports published their annual list of the best Nursing Homes, claiming that California had a higher percentage of quality skilled nursing facilities than any other state. I cried foul in an article titled April Fools in February? – US News and World Reports 2013 Best Nursing Homes Report.

A few days ago JAMDA published a paper titled The Association Between Quality of Care and Quality of Life in Long-Stay Nursing Home Residents With Preserved Cognition in which they found there was no correlation between quality of life and a high Five-Star rating. (See http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html for details on the CMS program.)
This is an important finding that should make consumers afraid and make operators of great skilled nursing facilities mad as hell. Here is why:

• When a consumer sees a high Five-Star rating, they would reasonably assume it would mean a superior experience for their loved one when, in fact, there is no evidence that this is true.
• It forces skilled nursing operators to spend their energy and efforts on getting or keeping a coveted 5 on the Five-Star rating which is ultimately a “check off the tasks” mentality. This means the tasks become more important than the residents. In reality it becomes a non-person-centered care approach.

Other Important Findings

• There were three other findings that were significant:
• The higher the physical impairment, the lower the quality of life. This would suggest two things: (1) That skilled buildings should put significant effort into maximizing residents’ physical abilities; and, that (2) operators should focus on adaptive technologies, devices and methods to give residents the maximum possible physical freedom.
• The study also found that the high levels of depression correlated with a lower quality of life. This finding is sobering and intriguing. While the initial “go to” would likely be anti-depressant medications under the assumption (reasonable) that being a long-term skilled nursing resident is, by its very nature, depressing. But serious and substantial thought should be given to the question of what can be done to make it a less depressing experience.

Implications for Person-Centered Care
The one thing that was absent (at least specifically) was a suggestion that quality of life is tied to the level of personal choice or control over what happens day-to-day and moment-to-moment in residents’ lives. The reason I find this curious is that, within the person-centered care movement, the ability to have more control is treated as the lynchpin of the concept. This would suggest that maybe person-centered care is more complicated or even something different altogether. Or perhaps, once a resident’s physical and emotional states are maximized they can enjoy the benefits of making personal choices.■

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