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Why 22 Maryland nursing homes lost their five-star ratings

Choosing the right nursing home can be tough. Without a reliable way to compare facilities, it can be even tougher.

Suppose you’ve been looking into various assisted living facilities for the past month, trying to find a home for a loved one. You’ve likely been using the federally run website Nursing Home Compare, which provides rankings, from one to five stars, for the 228 nursing homes in Maryland, among thousands of others nationwide.

Two weeks ago, consumers using Nursing Home Compare would have found that 81 of the 228 nursing homes in the state had an overall rating of five out of five stars. But this week, that same consumer would see only 59 Maryland facilities with five-star ratings.

What gives?

Effective Feb. 20, federal officials implemented new methodologies for calculating the rankings that appear on the site. Their goal — tightening the criteria for getting high scores — was admirable, several people said, but the result was potential confusion for consumers without addressing underlying problems with the rating system.

Many, if not most nursing homes in Maryland saw their scores drop (or in rare cases, increase) overnight by one or more spots on the five-star scale. For example, prior to the changes about 35 percent of all Maryland nursing homes had an overall score of five stars. After the changes, only 26 percent did.

Before the changes, 12 nursing homes in the state had overall scores of one star. After the changes, that number jumped to 27 facilities.

The federal Centers for Medicare and Medicaid Services (CMS) gives nursing homes a rating in three categories: results from onsite inspections by trained surveyors; performance on certain quality measures; and staffing levels. Those three ratings are then merged into a fourth overall rating.

The new calculations now take into account each facility’s use of anti-psychotic drugs, reflecting concerns that some nursing homes overprescribe the drugs to make patients easier to manage. Officials also made changes to how staffing levels are calculated and how certain quality measures are evaluated.

As a result, about two-thirds of nursing homes nationwide saw a decline in their quality rating and about one-third saw a decline in their overall rating, according to CMS officials.

Some advocates for consumers and families say the changes are a step in the right direction but that they don’t go far enough.

According to Kate Ricks, the board chair of advocacy group Voices for Quality Care, there is still a fundamental problem with the federal ranking system: Most of the measures are self-reported by the nursing homes.

“The changes do help somewhat,” she said. “I would like to say this is a wonderful thing they did, but frankly, I can’t get real excited about it because we’re still looking at star ratings that are primarily based on information sent in by the nursing homes themselves with no independent verification.”

Ricks said the most important measure for consumers to look at is the health inspections category, which gets its own ranking. That category reflects the results of independent evaluations of the facility.

But, the recent changes did little if anything to impact that category, Ricks said. The tighter standards implemented last week will still be based on self-reported data, she added.

Calls to multiple nursing homes in Maryland were not returned.


Md. facilities before changes: 

Five stars: 81 facilities

Four stars: 54 facilities

Three stars: 37 facilities

Two stars: 43 facilities

One star: 12 facilities


After changes: 

Five stars: 59 facilities

Four stars: 51 facilities

Three stars: 45 facilities

Two stars: 45 facilities

One star: 27 facilities

Source: Nursing Home Compare

About Alissa Gulin

Alissa Gulin covers health care, education and general business at The Daily Record.