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Nursing Homes Are Rated by the Government

By Rheingold Giuffra Ruffo Plotkin & Hellman LLP

The Centers for Medicare and Medicaid Services (“CMS”) rates nursing homes on a five-star system. The purpose of this system is to promote transparency in an industry that is not easily scrutinized by the public. The CMS releases these ratings every year. This post will go over the rating system and how it could affect your loved one’s care.

The rating system runs from five to one stars. A five-star rating indicates that the nursing home gives above average care. Conversely, a single star indicates that the care provided is significantly below average. These ratings are created based on three criteria.

First, the CMS reviews on-site inspections. The CMS considers records three years back and includes all manner of standard and compliance surveys. The surveys are conducted by CMS personnel to ensure that the nursing home is meeting minimum Medicare and Medicaid requirements.

Second, the CMS reviews staffing information. The CMS reviews staff hours, logs, turnover rates and the number of hours of care provided to each resident. The rating is weighted based on the amount of care each resident requires, to ensure that nursing homes are not penalized for more independent residents.

Finally, nursing homes are assessed on the quality measures. The quality measures include eleven different physical and clinical measures for the nursing home. The nursing home collects all of this information and turns it over to the CMS. The CMS reviews it for a variety of factors including the amount of antipsychotic medications dispensed for residents and other meters.

If your loved one was injured due to nursing home negligence, then you may want to contact a lawyer for a meeting. An attorney can go over your situation and help determine if you have an actionable claim. Lawsuits are not always necessary but it is important that you consider every issue before you settle or drop the issue because your loved one may have future medical bills due to his or her injuries in the nursing home. A lawyer can ensure that you fully review all of your options before you make a decision.

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