In the United States, over 15, 500 nursing homes that are Medicaid or Medicare certified or both provide care to approximately 1.3 million people. Nursing homes must meet federally mandated minimum standards as a requirement of Medicare and Medicaid payment. Many concerns regarding the quality of nursing home care and the adequacy of oversight and enforcement have been raised over the years. To address them, nursing home provisions under the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) were enacted. Unfortunately, reports of quality problems in nursing homes have not ceased.
Low staffing levels, new pressure ulcers (bedsores), and documented fire hazards are just a few of the concerns in nursing homes that persist. These issues are not to be taken lightly, given the fact that nursing home residents are frail and vulnerable individuals.
In 2008, the Five-Star Quality Rating System was launched by the Centers for Medicare and Medicaid Services (CMS) on its Nursing Home Compare website. It provided summary information to assist consumers in the process of choosing a nursing home in their area. CMS recently adjusted the methodology of these ratings, began posting more information regarding nursing home inadequacies from state health inspections, and is planning future endeavors to increase the star ratings’ reliability, as mandated by certain provisions in the Affordable Care Act (ACA) and the Improving Medicare Post-Acute Care Transformation Act (IMPACT). This issue brief provides national and state-level analysis of nursing homes quality scores based on these five-star ratings and explains pertinent policy considerations.