California has better nursing homes than any other state in the US . . . it has to be a joke right? The vaunted magazine US News & World Report has just released their 2013 list of best nursing homes. I was astonished to see that California led the way in having the most and highest percentage of highly rated skilled nursing facilities.
California did not lead by just a little bit. It “has twice as many highly rated homes as any other state, or in a region”. I found myself saying “Huh?” I live in California and in my many years in the senior housing industry I have been in maybe 2 or 3 thousand senior housing communities across with country and in more than half of all the licensed skilled nursing buildings in the State of California. I don’t think anyone who is objective about skilled nursing in this country, would ever try to make a credible argument that overall, California has the best nursing homes in the country. Within the skilled nursing community it is well known that the 5 star system is very flawed and in fact provides consumers very little in the way of useful information.
A quick google search will provide a variety of articles that question the 5 star rating system. Here is my take after reading the article and browsing the list:
- US News & World Report has done a shabby job of reporting. In fact, they didn’t do any serious reporting or they would have been more cautious about equating a 5 star rating with the highest quality care.
- It confirms that the 5 star system continues to be flawed. This is not to say it has no value, but I would argue that at best, it’s value is primarily as a early detection tool to identify and rule out terrible nursing homes.
- The one reliable conclusion you can draw from the list is that the highly rated skilled buildings are experts at getting a high rating 5 star rating.
- There are some really great skilled nursing buildings in California and other states that don’t have a 5 star rating. In fact often these buildings take on patients with complex problems and get terrific results, but because those patients are complex it hurts their star rating.
Your Turn
If you operate or work in a really great skilled nursing building in California, I am not talking about you! What do you think? What about your state? Steve Moran If you like this story it would be a great honor to me if you would subscribe to our email list.
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The 5 star system is very confusing and misleading. Most people equate it to the system for rating restaurants or hotels and assume that more stars mean better care, but that’s not the case. There are some very good nursing homes that get only a few stars because, for example they may specialize in accepting more critically ill patients, or specialize in a narrow niche such as brain injury rehab. They may be superior to other places with 5 stars. Just because a nursing home has 5 stars, it doesn’t necessarily mean it’s the best choice for an individual.
I absolutely agree that the federal government’s star ratings leave much to be desired. That is one reason why this year we stopped ordering homes within overall star ratings by total stars–putting a five-star home with a total of 14 stars in the three rating categories ahead of another five-star home with a total of 13 stars, for instance. Within overall star ratings, we now just put home in alphabetical order.
We feel, as you seem to, that such ratings do provide some guidance. We state that they should never be the only basis for making a choice, and provide a number of articles that we hope will educate families in making the best choice for them.
I do question why the star ratings would penalize high-intensity homes. The medical quality metrics represent baseline care to which any nursing home resident is entitled, the health inspections do not seem overly punative, and if anything, the nursing staff rating would be higher at a home with many residents needing a high degree of care simply because the number of nurses, and therefore the nursing time/patient, would be higher than at a home where care is of lower intensity.
I wish CMS would move a little faster to improve and supplement the rating categories. My special favorite is adding annual staff turnover rates in the RN and other nursing categories. I can’t help but feel that turnover is a key metric in evaluating the culture, and therefore the “caring factor,” of a nursing home.
Do you agree?
P.S. I am Health Rankings Editor for U.S. News & World Report. I created the Best Nursing Home rankings in 2008 and continue to have oversight responsibility for the methodology behind them.
Hi Avery:
Thanks for joining the conversation. I agree that staff turn over can be a great metric for the quality of the community. Again, my frustration was essentially based on my experience in primarily though not exclusively in California.
I am looking forward to the Twitter Chat on Thursday.
Steve Moran
I am helping my family look for an assisted living facility in Palm Beach Gardens, Florida.
The senior has some memory problems and suffers from depression. I look at the for U.S. News & World Report and found it somewhat confusing. Any advice would be great appreciated.
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