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Federal Government Raising the Bar for Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) recently unveiled a significant overhaul of its Nursing Home Compare rating system. The new changes will hold facilities to higher standards and should help families make more informed decisions when selecting a nursing home for a loved one.

According to CMS, “Changes in ratings reflect that CMS raised the bar for performance that should be recognized as high quality and anticipates nursing homes will make quality improvements to achieve these higher standards.”

The Nursing Home Compare system, which is available online, provides information about the quality of care in the 15,800 nursing homes that participate in Medicare or Medicaid. While the rating system tracks several quality of care measures, including pressure ulcers, use of restraints, extent of injurious falls, and staffing levels, it has received criticism after many poor-quality nursing home facilities were able to achieve high ratings.

In response, CMS has now raised the bar, making it more difficult to attain the best rankings. As detailed in a CMS factsheet, Nursing Home Compare 3.0 will include:

  • New Quality Measures (QMs): The rating system will now take into account the use of antipsychotic medication in nursing homes. One new measure addresses the use of antipsychotics for short-stay residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome, while a second measure reflects continued use of such medications for long-stay nursing home residents without such diagnoses.
  • Adjusted Staffing Algorithms: Nursing homes must earn 4-stars on either the individual “Registered Nurse” category or one of the other staffing categories to receive 4-stars on the “Overall” staffing rating and can have no less than a 3-star rating on any of those dimensions.
  • Expanded Targeted Surveys: State agencies will conduct specialized, onsite surveys of a sample of nursing homes across the U.S. to assess the adequacy of resident assessments and the accuracy of information reported to CMS.

As San Diego elder abuse attorneys, we are pleased that CMS is taking steps to refine its rating system, particularly by incorporating measures regarding the use of antipsychotic medications. While nursing homes are tasked with protecting the most vulnerable patients, studies have revealed that many facilities administer unnecessary or potentially inappropriate antipsychotic drugs to nursing home residents rather than treat the root cause of their behavior.