Government Toughens Standards Used to Rate Nursing Homes

The government-sponsored system for rating and ranking nursing homes has been revamped. As a result of the change, about a third of the nation’s nursing homes have seen a big drop in their scores, including almost a third of Oklahoma’s 300+ nursing homes.

Nursing Home Compare, operated by the Centers for Medicare and Medicaid Services, is a five-star rating system. Of the 308 Oklahoma homes listed in the system, 93 dropped by at least one star after the changes.

In the new ratings announced last week, Oklahoma has:

  • 38 nursing homes with a five-star ranking
  • 56 with four stars
  • 71 with three stars
  • 68 with two stars
  • 82 with one star

(Ratings were not available for three Oklahoma nursing homes.)

In other words, more than half of Oklahoma nursing homes continue to earn 3 or more stars and almost a third (31%) have 4 or 5 stars.

Nationally, the change in the Nursing Home Compare ratings resulted in 28% of our nursing homes dropping by at least one star. A drop in score as a result of the change in standards does not indicate a decline in the quality of the homes, but rather an elevation in the standards by which the federal government is now ranking nursing homes.

The government-sponsored online rating system is highly influential in the nursing home industry. About 1.4 million people consult Nursing Home Compare each year. Homes with high rankings often tout their scores in their marketing materials. For these reasons, the decision to elevate the standards of the five-star system is expected to result in nursing homes making improvements to keep up with the new, higher standards.

What Has Changed?

  • Staffing standards have been raised. Nursing homes must provide more hours of nurses on duty or more staff to assist nurses to maintain or regain their rankings.
  • A crackdown on the use of anti-psychotic drugs. Too many nursing homes use anti-psychotic drugs to make patients more docile and easier to manage, even if their diagnosis does not call for anti-psychotic medication.

The new standards permit the continued use of anti-psychotic drugs to treat schizophrenia, Huntington’s disease and Tourette ’s syndrome, but discourage their use for Alzheimer and dementia patients.

One industry observer said some Oklahoma nursing homes have been known to keep as many as 60% of their residents on anti-psychotic drugs.

OSU Center for Health Sciences pharmacology professor, Craig Stevens, told the Tulsa World: “Too often these antipsychotics can be used for chemical warehousing.”

USA Today quoted Robyn Grant, a spokesperson for the National Consumer Voice for Quality Long-Term Care, as saying:

“High rates of anti-psychotic use can indicate serious care problems, because they’re using them to drug residents, instead of having adequate staffing and truly meeting residents’ needs. When you’re using anti-psychotics, your residents could be suffering increased falls, they’re immobile, so you can see increases in pressure ulcers. They’re very problematic.”

Citizens can search Nursing Home Compare by facility name, locations or star ratings. In addition to ratings, the site also offers information about:

  • Health inspections: Nursing homes have an unannounced comprehensive inspection once a year.
  • Quality measures: Based on 11 factors that are evaluated using data the nursing homes are required to submit.
  • Staffing.

Oklahoma Nursing Home Ratings directory

Another source for information about area nursing homes is the Oklahoma Nursing Home Ratings directory, sponsored by the Oklahoma Health Care Authority. The site includes information on 291 nursing homes in Oklahoma.

The facilities can earn incentive reimbursements from the state for achieving good scores in nine areas:

  • Person-centered care
  • Direct-care staffing
  • Resident/family satisfaction
  • Employee satisfaction
  • Licensed nurse retention
  • CNA retention
  • Distance learning
  • Peer mentoring
  • Leadership commitment