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Nursing homes take ratings hit as government institutes tougher standards

| Friday, Feb. 20, 2015, 11:18 a.m.

WASHINGTON — Nearly a third of the nation's nursing homes are getting lower scores on the government's five-star quality scale, a reflection of tougher standards for ratings used by nearly 1.5 million consumers to assess care at more than 15,000 facilities.

The ratings, which will be posted Friday on the government's Nursing Home Compare website and by USA Today, reflect sweeping changes in the way facilities are evaluated. The revamped assessments include measures of facilities' use of anti-psychotic drugs, which can pose serious risks for older adults, especially those with dementia. They use more refined metrics to check for adequate staffing, a critical component of good care.

About 61 percent of all nursing homes got lower quality-of-care scores as a result of the changes, but the declines weren't dramatic enough in most cases to affect a facility's overall rating, a USA Today analysis shows. About 28 percent of nursing homes dropped one star in their overall ratings, including more than 1,200 that lost their coveted five-star status. About 3 percent of facilities fell two stars.

The ratings are a closely followed measure of nursing home quality. About 1.4 million people used the Nursing Home Compare website last year to help families choose a facility. Nursing homes use the scores to gauge their stature and performance, and those with high ratings often incorporate the rankings into their marketing materials.

The scoring “raises the standard for nursing homes to achieve a high rating,” said Thomas Hamilton, director of survey and certification at the federal Centers for Medicare and Medicaid Services, which regulates nursing homes and runs the Nursing Home Compare website.

Hamilton said the ratings system is supposed to evolve and push nursing homes to improve continuously. But the standards haven't changed since 2008, he said, and CMS thought it was time to set a higher bar. The new scores reflect that tougher standard, he said, and “not necessarily any underlying change in the quality” of care.

USA Today reviewed ratings data for the more than 15,000 nursing homes included on the Nursing Home Compare website, which covers all facilities that participate in Medicare and Medicaid. Each nursing home has an overall rating based on scores in several distinct categories: performance in state inspections, staffing levels and quality of care. Among the findings:

• The average overall rating among all nursing homes dropped from 3.46 stars to 3.14 stars. Overall ratings increased for 341 homes, or 2.3 percent, under the new measurement system.

• The biggest drops happened in scores for quality of care, where the average for all nursing homes fell from 4.18 stars to 3.3 stars. No ratings category changed more, not only because it reflects the addition of data on anti-psychotic drugs but because other quality measures were made tougher.

• Nearly 20 percent of all nursing homes got the lowest possible score on the new measure of anti-psychotic drug use — CMS scored them on a curve, giving one star to homes ranked in the bottom fifth. Facilities were docked for using the drugs on residents unless they were indicated for specific conditions, such as schizophrenia, Huntington's disease or Tourette's syndrome.

• The new staffing measures, which distinguish between nursing staff and lesser-trained aides, had little effect on overall staffing ratings. As many as 12 percent would have lost a star had they not beefed up their staffing. Fewer than 8 percent lost a star on the staffing measure.

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