What are the nursing home quality ratings?

To achieve the best possible results, health care quality is:

Quality ratings are based on information from two sources: (1) health and safety inspections conducted by a state agency at least once a year in each nursing home; and (2) regular assessments nursing homes conduct that cover residents’ health, physical functioning, mental status and general well-being. The monthly assessment information must be reported to the federal government by the nursing homes, along with information about how many staff they have working. For more information, visit Nursing Home Compare, a website run by the Centers for Medicare & Medicaid Services (CMS) that collects and reports nursing home quality information.

How do I select nursing homes to compare?

You can select nursing homes in several ways:

How did we analyze this information?

MONAHRQ itself does not analyze information to calculate quality measures’ rates. Quality measures with pre-calculated rates from multiple sources of information can be imported to MONAHRQ. These rates are compared with national and state benchmarks in this report. Nursing home information on MONAHRQ is obtained from the federal Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare ratings. The ratings are calculated by CMS using information that individual nursing homes provide to them. For more information on the methods used by Nursing Home Compare, visit the Nursing Home Compare website.

How are the quality ratings assigned?

Nursing Home Compare assigns 5-star ratings based on three types of information: health and safety inspections, quality measures, and staffing. More stars means better quality. The overall star rating for an individual nursing home begins with a nursing home’s health inspection rating. Stars are then added or subtracted based on ratings of quality and staffing. For more information, visit Nursing Home Compare.

Other Information Sources

CMS provides the raw facility scores in all 3 rating domains used to calculate star ratings: survey, staffing, and quality. A method that assigns percentiles based on raw scores is used to rank and compare nursing homes within peer groups in all three domains.

How are Nursing Homes state or regional ratings calculated?

The national level nursing home comparison 5 star ratings in MONAHRQ use ratings from CMS’s Nursing Home Compare database. However, the peer level ratings are computed in MONAHRQ. For peer-level comparison, the nursing homes are compared against others in the state or county in which they are located using the absolute percentile method. The absolute percentile method creates a number of different means of comparison among nursing homes, along with comparisons to a peer group and state average.

All three rating sections -- Quality, Health Inspection, and Overall Staff Available – are scored this way. MONAHRQ computes the domain level summary scores at the peer level; however, the overall score (rollup of all three domains) is not computed at the peer level

Nursing Home CAHPS

Each of the composite measure ratings is creating by scoring the responses to each question, or assigning a numeric value to each response. For example, in a yes/no question, a “no” can be given a value of 0 and yes a value of 1. The values of the responses to each individual question are totaled to create the value for the composite measure.

The value of each composite measure is graded like on a test, where the result can be from 0 to 100. A star rating for the composite measure is assigned based on the final result:

If there are fewer than 20 responses to questions that can be used for a composite measure, the result is not calculated.

There are five composite measures that are combined to get an overall rating for the survey. They are added together and then divided by the number of composite measures to get an overall score from 0 to 100, which is then assigned an overall star rating. The ratings are assigned in the same way as the composite measures.

If one of the composite measures has fewer than 20 responses and could not be calculated, the overall rating is made up of the remaining composite measures and then divided by the number that were used.

How do I interpret the nursing home quality ratings tables?

The ratings tables show quality ratings for nursing homes. You can use this information to help you choose a nursing home. The best way is to search for patterns in the ratings. Some nursing homes do well in all areas. Others do well in some areas but not others. Still others show problems everywhere. Some do well with short-stay patients, others are best for long-stay patients, and some are good choices for either type of patient. Look for these patterns. At the same time, if there is an aspect of nursing home care or a health or safety risk that is of particular concern to you, you should give more weight to information related to those concerns.

You can switch your comparison view to compare nursing home at the national, state/peer, and county level.

You can also compare up to five(5) nursing homes. The ratings tables are divided into sections that show ratings by three domains: Health Inspection, Quality, and Staffing. A nursing home is rated by comparing it to other nursing homes and to national or state/peer or county.

More details on individual measures rates within each domain can be found in nursing home profile report.