Medicaid Updates Nursing Home Ratings, Helping to Make Long-Term Care Decisions Easier

One of the hardest decisions to make is determining when a dear loved one needs long-term care. Realizing that families can no longer provide care at home and a nursing home is the practical option is difficult. Many turn to Medicaid to help with the financial toll of nursing home care. However, selecting which home to trust with your family member’s care adds to the challenge. The Centers for Medicare and Medicaid Services (CMS) recently announced some revisions to its five-star rating system for nursing homes to help families with this decision.

How Are Ratings Calculated?

Nursing homes are graded in three ways. First, trained surveyors perform inspections on site. These include annual inspections and those prompted by a complaint. Second, specific quality measures are assessed. Eleven quality measures are scored based on clinical data reported by the nursing home themselves. Lastly, the staffing of the home influences their grade. While the federal government requires enough staffing to adequately care for residents, there is no specific ratio. Therefore, the CMS staffing rating is the only existing guideline currently. Staffing is calculated by Registered Nurse (RN) hours per resident day and total staffing hours per resident day, including RNs, Licensed Practical Nurses (LPN), Licensed Vocational Nurses (LVN) and Certified Nurses Aids (CNA). By going to the Nursing Home Compare website, users can look at overall ratings or view how each home scores in these three categories separately. While the rating system was launched in 2008, two new factors are being considered in their quality measurements.

  • Antipsychotics. Homes will be rated on their use of antipsychotics. Research has shown that homes often prescribe these medications for conditions that do not require them. Now, they will be scored by how much they use antipsychotics on long-term and short-term patients.
  • Staffing. CMS has updated how much staffing influences a home’s overall score. Nursing homes must now earn four stars in their total staffing or RN rating to get at least an overall four-star rating.

CMS Warns of Initial Decline

Before the recent revisions, about 80 percent of homes received a four or five-star rating. CMS estimates now only about 49 percent will get these high ratings. About two-thirds will see a drop in their quality ratings and one-third will see decline in their overall score. However, CMS is confident the scores will increase as nursing homes work hard to make improvements in line with the quality of care reflected by the scoring process. In fact, benefits are already being seen. For example, CMS has been focusing on reducing the amount of antipsychotics for the last couple years. By the end of 2013, there was a 15 percent reduction compared to 2011. In coordination with the National Partnership to Improve Dementia Care, CMS has set a goal to reduce antipsychotic use by 30 percent by the end of 2016.

Selecting a Home

While Nursing Home Compare is extremely helpful, selecting a home for your loved one requires much more than viewing a rating system. Many factors much be considered, including proximity to family, amenities, quality of life offered, treatment required by the patient, costs and numerous other factors. An on site visit and interview with staff will help you get a feel for the atmosphere. While comfort and quality are your top priority, cost cannot be ignored either. Families must consider not only the out-of-pocket costs, but also a strategy to protect your loved one’s assets. An experienced Medicaid attorney can help protect your assets, as well as determine what coverage you qualify for. Talk to an attorney at The Elder Care Firm about the use of trusts, transferring assets, purchasing annuities or a strategy that increases income and resource allowances for family members. Contact us to get started.

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