The purpose of nursing home quality measures
Quality measures are standardized tools used to assess, track, and report on the quality of care delivered in a nursing home. Created by the Centers for Medicare & Medicaid Services (CMS), these measures provide a snapshot of a facility's performance in key areas, such as patient safety, health outcomes, and resident satisfaction.
By regularly collecting and publishing this data, CMS aims to increase transparency and empower consumers to make more informed decisions about long-term care. For nursing home administrators, monitoring and acting on these quality measures can drive continuous improvement in care delivery, staff training, and compliance with federal and state regulations.
How CMS uses quality measures
The most visible use of quality measures is the CMS Five-Star Quality Rating System, which is displayed on the Medicare.gov Care Compare website. This rating helps consumers easily compare nursing homes based on three main components:
- Health Inspections: Based on recent on-site inspections and complaint investigations.
- Staffing: Measures the number of nursing staff hours per resident per day.
- Quality Measures: Based on a subset of resident health indicators.
The quality measure component of the rating system provides specific data on resident health and well-being, both for those with shorter stays (typically for rehabilitation) and for long-term residents.
Short-stay vs. long-stay quality measures
Nursing home quality measures are separated into two categories based on the length of a resident's stay. This distinction is important because the health needs and care goals of a short-stay resident (100 days or less) differ significantly from a long-stay resident (101 days or more).
Short-stay resident measures
These measures primarily reflect the outcomes of residents admitted for post-acute care, such as those recovering from surgery or a hospital stay. Key indicators include:
- Hospital readmission rates: Measures the rate of unplanned hospital readmissions within 30 days of discharge from a prior hospital stay.
- Functional status: Measures whether residents' need for help with daily activities has increased or decreased.
- Pain management: Tracks the percentage of residents who report moderate to severe pain.
- Vaccination rates: Monitors residents who received the influenza and pneumococcal vaccines.
Long-stay resident measures
These measures focus on the health and quality of life for residents who consider the nursing home their permanent home. Indicators cover common chronic conditions and potential complications, such as:
- Pressure ulcers (bed sores): The percentage of high-risk residents who have developed new pressure ulcers.
- Antipsychotic medication use: The percentage of long-stay residents receiving an antipsychotic medication.
- Falls with major injury: The percentage of residents who experience one or more falls resulting in major injury.
- Physical restraints: The percentage of residents who were physically restrained.
- Unplanned weight loss: The percentage of residents with significant, unplanned weight loss.
- Urinary tract infections (UTIs): The percentage of residents with UTIs.
How to research and interpret quality measure data
For families and caregivers, understanding and using quality measure data is crucial for selecting the right facility. The primary tool for this is the Medicare.gov Care Compare website, which provides detailed reports on every Medicare-certified nursing home in the U.S..
A comparison of quality indicators and subjective factors
| Feature | Quality Measures (Quantitative) | Subjective Factors (Qualitative) |
|---|---|---|
| Source of Information | Publicly reported data from CMS.gov, based on clinical assessments (Minimum Data Set, or MDS) and claims data. | Anecdotal evidence from resident and family surveys, personal observations during visits, and informal feedback. |
| Objectivity | Provides a standardized, objective comparison across facilities based on specific health outcomes and care processes. | Highly personal and can vary widely from one person's experience to another. |
| Interpretation | Lower scores are often better, especially for problem-based measures like falls or pressure ulcers. A low score indicates fewer negative events. | Depends on individual priorities and perceptions of care, staff interactions, and resident happiness. |
| Limitations | Data can be complex and may not capture a single resident's experience or the full picture of their health. Facilities may also over-focus on improving metrics rather than overall care. | Highly subjective, may not be representative of the entire facility, and can be influenced by personal biases. |
It is important to use both quality measure data and subjective observations when evaluating a nursing home. The quantitative data provides a standardized baseline for comparison, while subjective factors offer deeper insight into the day-to-day resident experience.
How to use Care Compare
To effectively research a facility using quality measures, visit the Medicare.gov Care Compare tool. Use the website to:
- Filter by location: Find nursing homes in a specific geographic area.
- Compare ratings: Look at the overall star rating, as well as the separate ratings for health inspections, staffing, and quality measures.
- Review detailed measures: Click on a facility to see its specific performance on individual short-stay and long-stay quality indicators.
- Check trends: Some data sources offer historical performance trends for a facility, which can show if care quality is improving or declining over time.
The crucial role of staffing levels
While staffing is its own component of the five-star rating, it is critical for understanding the underlying reasons behind a facility's quality measures. Sufficient and consistent staffing levels directly impact a nursing home's ability to provide timely, high-quality care and prevent negative health outcomes. Inadequate staffing is frequently linked to worse care, such as higher rates of pressure ulcers and falls.
Conclusion: Making an informed choice
Quality measures are an invaluable resource for assessing nursing home performance, providing transparent, standardized data on key indicators of resident care. By understanding the different types of measures—short-stay and long-stay—and how to interpret the data on websites like Medicare.gov Care Compare, families can confidently compare facilities. Combining this objective, quantitative data with personal observation and subjective feedback is the most effective approach for making an informed decision that ensures the safety, well-being, and high-quality care of a loved one.
The importance of continuous quality improvement
For nursing home leadership and staff, the focus on quality measures is a driver for continuous quality improvement (CQI). By proactively monitoring data, identifying areas for improvement, and implementing effective care protocols, facilities can not only boost their star ratings but also significantly enhance the quality of life for their residents.
Actionable steps for family members
As you research nursing homes, follow these steps to leverage quality measures effectively:
- Start with Care Compare: Use the official Medicare website to get a baseline understanding of a facility's health inspection, staffing, and quality measure ratings.
- Review specific measures: Don't stop at the star rating. Dig into the details on specific indicators like falls, pressure ulcers, and medication use to see where a facility excels or struggles.
- Conduct on-site visits: Arrange multiple visits at different times of the day. Observe the staff's interactions with residents and the overall environment.
- Engage residents and families: If possible, speak with current residents and their family members to gather first-hand accounts of their experience. Inquire about how management responds to feedback.
- Prioritize your needs: The best facility is one that meets the specific health requirements and quality-of-life preferences of your loved one. Use quality measures to narrow your search and find a facility that aligns with your priorities.
