Blog » How Long-Term Care Facilities Can Improve Quality Scores

How Long-Term Care Facilities Can Improve Quality Scores

Created Mar 16 2015, 08:00 PM by Lippincott Solutions
  • quality scores
  • Center for Medicare and Medicaid Services
  • nursing homes
  • long-term care
  • patient care
  • quality
  • CMS
  • nursing
  • LTC

Tuesday, March 17, 2015
How Long-Term Care Facilities Can Improve Quality Scores

Called the Five Star Quality Rating System, the scores take into account more than 12 million assessments of the conditions of nursing home residents from more than 15,000 LTC facilities across the nation. The scoring system gives facilities a rating anywhere from one to five stars, and also includes scores for separate categories such as health inspections, quality measures, and staffing.

CMS recently changed the Five Star Quality Rating System criteria – measurements that hadn’t been revised since 2008. However, the tougher standards, revamped assessments, and refined metrics have had a negative impact on LTC facilities’ ratings. A recent report posted on the CMS Nursing Home Compare website shows that nearly a third of LTC facilities are experiencing a dramatic drop in their scores.

According to CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway, the agency made changes to how they evaluated nursing homes for two main reasons: to help consumers differentiate between facilities more easily and to  provide  facilities with a better incentive for quality improvement. “You do need to raise the bar,” said Dr. Conway. “When it becomes relatively easy to achieve a high rating, that’s not going to incentivize the same level of improvement,” he continued.

The sweeping changes in the way CMS evaluates facilities include revamped assessments of their use of anti-psychotic drugs, which can pose serious risks for older adults, especially those with dementia. Refined metrics were also implemented to check for adequate staffing. The tougher standards resulted in lower scores for approximately 61% of all facilities with 28% of them losing one star and 3% losing two stars. More than 1,200 LTC facilities lost their coveted 5-star status, a bragging point used heavily in marketing and staff recruitment.

A drop in status will most likely have a significant impact on a facility’s bottom line. More than 1.4 million consumers used the Nursing Home Compare website last year to discover facility ratings. CMS cautions consumers to take other factors besides the ratings into consideration when evaluating nursing homes. For example, if a patient needs specialized care, consumers should look into the facility’s ability to provide those services. Also, families need to consider the location of the nursing home. How easy will it be to visit the resident? Visits improve a resident’s quality of life and well-being. A 4-star facility located nearby may be preferable to a 5-star facility an hour’s drive away.

So, what can nursing homes do to improve quality and achieve higher ratings? Here are four strategies LTC facilities can implement right now:

  1. Train nursing home staff—particularly nursing staff—to be vigilant for residents’ changes in condition and to effectively communicate and document those changes. Changes in condition can leave residents more susceptible to falls and fall-related injuries. This is just one tool LTC staff can use to improve patient safety. More information can be found at:
  2. Implement an EHR—Depending on the software system and how it is implemented, utilized, and nurtured, implementing an electronic record can have a significant effect on quality and safety in LTC. EHR systems can help facilities reduce medication errors, improve documentation, and facilite information exchange along the care continuum.
  3. Take advantage of quality support materials -- The Nursing Home Quality Initiative (NHQI) website provides materials and support to help facilities improve quality. More information can be found at:
  4. Use evidence-based LTC procedures: Evidence-based best nursing practices help LTC facilities implement quality standards of care throughout the system.  Lippincott’s institutional software includes the latest evidence-based practice content that expertly supports all aspects of the long-term care provider market, from large multi-entity systems to small businesses.  More information can be found at:

What other things can LTC facilities and their clinical staffs do to improve quality of care for residents?  Tell us in the comments below.