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How Nursing Homes Are Rated and Compared

Nurse helping elderly woman Most nursing homes, skilled nursing facilities, and long term care facilities accept health insurance payments from Medicare and Medicaid. To be able to receive these types of federal funds, they must agree to follow guidelines set forth by the Centers for Medicare & Medicaid Services (CMS) on a variety of topics. CMS is part of the U.S. Department of Health and Human Services. CMS also has the authority to conduct inspections of the facility and their practices.

Approximately 6,000 people are employed with the Centers for Medicare & Medicaid Services. A large role of CMS is to conduct inspections of nursing home facilities and look into almost all aspects of their operations, ranging from residents’ health, fire safety, staffing levels, quality of care, billing, HIPAA compliance, and more. In each category surveyed, a nursing home can be rated between 1-5 stars. CMS also strives for complete transparency by allowing prospective residents and their families to compare nursing home facilities in their area in order to make the best possible choice.

Nursing homes nationwide can be compared among the following categories:

Health Inspections

A nursing home health inspection rating involves whether the facility meets basic federal and state licensing standards. Regulators look at whether the facility hires enough staff members, manages medication properly, and stores food properly, for example. Inspectors look into the protocols and procedures used by the facility to provide care to residents and the interactions between the nursing home staff and its residents. Health inspectors can analyze staff manuals and conduct interviews of staff members and residents.

Fire Safety Inspections

Nursing homes are inspected based on fire safety standards established by the National Fire Protection Association and standards of the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers. In a fire safety inspection, investigators will review all aspects of the nursing home’s operations, including construction, building design, and fire prevention measures used to protect residents from smoke, gas leaks, and electrical failures.


One of the most important features of a nursing home is its staffing levels. Understaffing is becoming a systemic problem in the nursing home industry, and since 2014, health inspectors have cited nearly 1 in 8 nursing homes for not having enough nurses on staff at a given point in time. CMS reviews payroll data to look for the total number of staff, which could include Registered Nurses (RN), Licensed Practical Nurses (LPN), nurse aides, and Physical Therapists (PT), and then calculates a ratio of staffing hours per resident day. Nursing home staff members should meet the proper certifications for that specific license, including federal and state standards.  Otherwise, a nursing home could be liable for negligent hiring. Generally speaking, higher staffing levels can mean higher level of care, as more staff members will be available for tasks such as administering medication and responding to complaints.

Quality of Resident Care

Quality of resident care is a broad category and can help differentiate between the overall care administered by facilities. The rating for quality of resident care depends on different “Quality Measures.” Some of these measures include the percentage of short-term residents re-hospitalized after admission, percentage that needed outpatient emergency room treatment, percentage that got anti-psychotic medication for the first time,percentage with pressure ulcers/bedsores that are new or worse than before, and percentage that report moderate to severe pain. CMS also looks to how effective a facility is at administering preventative measures for illnesses, such as the flu and pneumonia. Finally, CMS seeks to evaluate a nursing home’s effectiveness at meeting goals for a patient’s stay, the rate of successful returns to home, and propensity for avoiding setbacks such as falls.

Has Your Loved One Suffered Harm in a Nursing Home?

Federal law gives nursing home residents basic rights – the right to proper care, hygiene, and to be free from chemical and medical restraints. Our law firm is dedicated to fighting to protect those rights, and when violations occur, we have the resources to consult with experts, investigate the situation, and file lawsuits against the appropriate parties. Call Nahon, Saharovich & Trotz at 800-529-4004 for a free consultation with a nursing home abuse lawyer today. You can also fill out our online form. Our attorneys handle cases involving nursing home negligence and abuse in Tennessee, Arkansas, Mississippi, Missouri, and Kentucky, and we look forward to showing you why NST is the way to go.