Shouldn't the Stars that Rate Facilities be the Residents?

Who decides whether a nursing home gives good care? And who has the measures to say definitively whether a facility provides an excellent quality of life for its residents?

USA Today seems invested in the Five-Star rating program. Predictably, they reported that for-profit long-term care facilities rate much lower than nonprofit homes, noting that 27% of the for-profit homes listed in their analysis rated only one star.

By contrast, industry experts like AHCA, the American Health Care Association, say that the Five-Star program is flawed because it rates on a curve, meaning that fully one-fifth of all facilities must fall in the one-star category, regardless of how they perform. Furthermore, fifty percent of what constitutes a star rating is state survey findings, which are notoriously unreliable and variable from state to state, within states, and among evaluators. There is a lot of room for individual interpretation and preference in evaluator ratings, so it is easy to see how a facility’s profit status might influence even evaluators’ ratings, leading to poorer ratings for for-profit facilities and thereby resulting directly in fewer stars.

My point, though, is not to comment on the Five-Star program, but instead to raise the issue that in all of this rating and evaluating, customer satisfaction, the customer experience is absent. In the Guest Blog, CMS Five-Star—Friend or Foe, long-term care commentator and blogger Anthony Cirillo cites the 2008 study by the research and consulting firm Holleran, “In an analysis of data from more than 12,000 nursing home residents and family members across 32 states, Holleran found little to no association between the one through five ratings given by CMS and actual satisfaction ratings. Holleran's research reflects satisfaction across skilled nursing facilities primarily in the nonprofit sector. Nursing homes rated as below average by CMS are garnering satisfaction ratings in the mid 80s, according to Holleran, which suggests these results show there are missing key elements in the Five-Star Rating system.”

I think this is unfortunate and really misses the point, since long-term care consists of human beings providing intimate services to other human beings. It seems logical that the views of the recipients of care quality of life would be directly influential in determining how a facility ranks in the Five-Star system.

Even though this is the case, and I agree that the Five-Star system is flawed, I do believe it is here to stay. I think the public demand for transparency is growing as the boomers enter the marketplace for long-term care services and I hope the industry will do what it has historically done—rise to the occasion and use the Five-Star rating system to raise the bar on compliance and performance. I look to long-term care to capitalize on this program as an opportunity for reflection, analysis, and continuous improvement.