Nursing Home and Adult Care Home
Rating Systems
Jill Passmore, Lead Regional LTC Ombudsman - Triangle J Area Agency on
Aging
The STATE
Adult Care Home Four Star Rating System, implemented January of 2009, is
based on compliance with STATE rules or MINIMUM standards. Ratings will be posted on the N.C. Division
of Health Service Regulation’s (DHSR) Adult Care Licensure
website. (Information about the STATE rating system can also be found
on the DHSR website. )
Here are some highlights:
- Adult Care Home Star Ratings are based on the results of annual and
follow-up survey inspections by State Surveyors, and findings (Type
A and Unabated Type B violations) by the local County Department of
Social Services which have been reviewed and concurred by the Division
of Health Service Regulation.
- The ACH Star Rating System is not like a
restaurant star rating system which gives maximum stars for
going above and beyond minimum standards.
- This rating system is based on an evaluation of the
homes compliance with MINIMUM standards or STATE rules and is based
on a 100 point scale. All facilities start with 100
points.
- Ratings are not based on a facility’s comparison with
other adult care homes.
- The highest rating that an Adult Care Home can receive is 4 stars, after scoring 100
or greater points on two consecutive annual surveys. No Adult Care
Home will receive 4 stars until 2010.
- Demerit points are subtracted from a facility’s rating score for
citations and violations of non-compliance cited during an inspection.
Demerit points may also be issued if action is taken by DHSR against a
facility’s license.
- Facilities can receive merit points, which will positively affect
their ratings, for correcting deficiencies and violations and
for installing or contracting for a power backup generator or
participating in a quality improvement program.
- A facility may request a follow-up inspection not less than 60
days after the date of the annual inspection if a facility
receives citations on its annual inspection with no Type A or Type B
violations and the rating from the annual inspection is one or
zero stars. Follow-up inspections will be completed depending upon
Division of Health Service Regulation (DHSR) staff availability.
Sources: NC DHSR letter to providers January, 2009; TJAAA Ombudsman
Program
The FEDERAL Nursing
Home Five Star Rating System, implemented December of 2008, is
based on compliance with FEDERAL regulations or MINIMUM standards. Star
Ratings can be found at: http://www.medicare.gov/NHCompare.
Nursing Home Ratings are based on three sources of
data-- health inspections, staffing and quality measures. Here are
some details:
- Health inspections look at ALL major aspects of nursing
home care, about 180 different items, and are conducted by trained state
surveyors, looking to assure compliance with FEDERAL regulations.
- Staffing ratings are derived from a facility's
self-reported staffing ratios 2 weeks prior to the (unannounced)
annual survey. Keep in mind that this is merely a 2-week
view reported by the facilities themselves and may not be reflective of
staffing on a long-term basis.
- Quality Measures provide an in-depth look at how well each nursing home
performs on ten important aspects of care, including the residents' health, physical functioning, mental
status, and general well being. Again,
this is self-reported data and represents only a few of the many aspects
of care important to residents.
- Nursing Home ratings will remain in effect for one year, so
consumers should check with their Ombudsmen to ask if anything has
changed during that period of time. Turnover in key administrative staff can affect quality
of care fairly quickly. Just because a facility received 5 stars
on its annual inspection does not mean that it is still providing 5-star
care; the same holds true for a 1 star facility.
- Nursing Home Star Ratings are based upon their comparison
with other nursing homes.
Note: Both the STATE Adult Care Home Star
Rating System and the FEDERAL Nursing Home Star Rating System provide a
“snapshot view” of facilities, and were designed to provide
consumers information with which to make informed decisions about placement.
While they provide valuable information, consumers should ALWAYS be
encouraged to visit facilities, observe how residents are treated, speak with
staff, ask questions and use their 5 senses when evaluating a facility.
Ratings are one piece of the puzzle.
