NursingHomeCompare – Reasons You Shouldn’t Use Medicare’s ‘5-Star Rating’ SystemNursingHomeCompare - Reasons You Shouldn't Use Medicare's '5-Star Rating' System

Many of you have likely visited the other major rating system available for nursing home options –  Medicare intends for this website to be a comprehensive resource for families and elders who are searching for a nursing home.  The rating system was launched officially in 2008.  This website was billed as the “go-to” resource for many American families looking for a nursing home for a loved one.

A Complicated and Hard to Interpret Rating System

Medicare’s rating system for nursing homes has been controversial since its launch in 2008 to industry leaders, nursing home administrators and marketing staff, and of course, to nursing home consumers.  Both sides – nursing home administration and consumers alike – struggle to understand what these highly complicated ratings really mean. This is despite Medicare’s attempts at providing explanatory links to each of the 3 sub-sections of the rating and a full website with multiple subpages explaining each aspect of the rating system.   If it requires this much explanation, is it really a good rating system for consumers?

What’s Missing from Medicare’s Rating?

There is one major, and arguably more important than all three parts of the rating system combined, missing piece from this “go-to” resource – customer satisfaction. There is no measure in Medicare’s “5-star Rating” system that directly incorporates resident or family satisfaction with the nursing home.  Isn’t this what we get from other popular sites that provide “5-star Ratings”? Such as Yelp, AngiesList, Amazon, TripAdvisor, and every major website out there that sells or advertises just about anything?  It has become the modern standard for consumers to read online reviews of the product you’re considering buying.  

The Controversial History of NursingHomeCompare

NursingHomeCompare has received recent negative publicity and academic scrutiny about the quality of their rating system in measuring nursing home quality accurately. The major concerns being that 1) much of the data is self-reported by the nursing homes and can be manipulated by savvy companies and administrators and 2) that the measures that go into the rating are highly complex in how they are calculated and not accurately comparable between facilities – overall giving an inaccurate/misleading picture of the quality of the nursing home.  

controversial New York Times article from 2014 did lead to limited changes in the rating system to make it more difficult to manipulate self-reported data from one part of the 3 part rating – the staffing measure, which was discussed in length in the article. Mandatory payroll data submission will become the new standard for all nursing homes beginning summer of 2016. This will make the rating system slightly less vulnerable to manipulation by providers.  

However, this part and the quality measures will ultimately still remain self-reported and highly complex.  In addition, there are already complex but easy to use tools available to providers to calculate their 5-star rating based on certain changes in staffing patterns. This solution does not fix a broken rating system that is based on information from biased providers and regulators and not from the consumers they serve.

So What is NursingHomeCompare Missing?

What’s missing is the measure of quality of life for residents in the nursing home – this is what creates happy residents and families.  Aren’t you looking for a place that will provide the best possible quality of life for your loved one? A 2014 study, published in the Journal of the American Medical Directors, reported that quality of life elements of nursing home living, such as privacy, autonomy, and relationships with support workers, was not associated with the CMS star rating of a facility.  Of course we want our loved ones safe and healthy, that’s a given.  But we also know they are getting older and will continue to decline. When we’re looking at the place they will spend their last years of life, the most important factor isn’t whether or not they will be in a nursing home with high staffing or a nursing home with few regulatory deficiencies, but rather, the question is, will they be in a nursing home that makes the people who live there, as well as their families, happy?  The nursing home compare “5-star Rating” system does not measure this.

So How Do I Pick a Nursing Home if NHCompare is Not the Right Resource?

While we wait for Medicare to fix their broken rating system, look to other people’s experiences and advice to help you select a nursing home, just like you likely do with other important decisions.  Find out which nursing homes people recommend from theirs or a loved one’s experience at that nursing home, this is how you will get the most accurate picture of whether or not it is the place you want your loved one in.  Another fantastic resource is websites that actually provide consumer reviews – like

Kristina Williams is a gerontologist, licensed nursing home administrator, certified assisted living administrator, and former certified nurses aide, with a passion for improving how our society views and supports our elders. She has worked in a variety of senior housing settings including adult-day health, nursing homes, assisted living, independent living, and Continuing Care Retirement Communities. Her specific areas of expertise and interest include senior housing, design for the aging, caregiving, intergenerational programming, dementia, end-of-life care, home funerals, the new retirement, continuity of care, leadership, and healthcare.


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