Alliance of Family Councils of NY

Changes Coming to Nursing Home Compare

February 22, 2015. In December 2008, in response to popular demand, the Centers for Medicare and Medicaid Services (CMS) launched a rating system for all nursing homes that participate in either Medicare or Medicaid. A nursing home can earn from one to five stars on an overall quality rating, which is based on three specific sub-ratings: health inspections, staffing, and “quality measures.”

Health inspections. Of these three criteria, this one is the most heavily weighted. It is based on data from the annual health inspection surveys that the Department of Health conducts in every nursing home. It also includes findings from the previous three years of complaint investigations.

Staffing. This criterion is based on nursing hours per resident as provided by RN’s, LPN’s, and CNA’s.

Quality Measures. Perhaps the most mysterious of the three criteria, this one is based on MDS (Minimum Data Set) indicators measuring the quality of care in nursing homes. The precise indicators selected for this criterion have varied over the years, but as of this writing they are:

The provisions on antipsychotic drugs have newly been added and reflect the growing awareness of the seriousness of this issue.

The intent of this ratings system has been to make it easier for consumers to research the quality of nursing homes and make informed choices. However, since the beginning these ratings have been plagued with controversy. The major criticism is that the second and third of the three criteria are based on data reported by the nursing homes themselves without outside verification. Nursing homes have an incentive to inflate their data and some have done so. While state surveys are officially unannounced, nursing homes know approximately when they will take place and some have temporarily beefed up staffing levels in preparation. Quality Measures ratings have also often been inflated and often have little correlation with the other criteria. Five stars on Quality Measures are not uncommon for nursing homes with poor overall ratings, and the figures are virtually meaningless.

This situation is in the process of changing. CMS has just announced that it is raising its standards for Quality Measures. This means that nursing homes will have to work harder to achieve a certain star rating. In addition, two new standards have been added on antipsychotic drug use for both long- and short-stay residents.

Another significant change will be an adjustment in the way staffing data is collected. Self-reported staffing data will be examined more closely. Eventually a system will be put into place that will verify staffing levels based on nursing home payroll data. We may hopefully see that sometime in 2016.

Once these changes are fully implemented, Nursing Home Compare will become a much more reliable instrument for consumers than it is at the present time.


Centers for Medicare and Medicaid Services. “Fact sheets: Nursing Home Compare 3.0: Revisions to the Nursing Home Compare 5-Star Quality Rating System.” February 12, 2015.

Centers for Medicare and Medicaid Services. Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide. February 2015.

Thomas, Katie. “Medicare Revises Nursing Home Rating System.”, October 6, 2014.

Thomas, Katie. “Medicare Star Ratings Allow Nursing Homes to Game the System .”, August 24, 2014.

Thomas, Katie. “Medicare Toughens Standards on Nursing Homes .”,February 20, 2015.