CHAPTER 22 | Federal Regulations 359
Care Compare Nursing Home Five-Star Quality
Rating System CMS created the Five-Star Quality Rating System to help potential residents and consumers, their fami- lies, and caregivers compare nursing homes more easily and to help identify areas about which they might want to ask questions.16
The Nursing Home
Compare website features a quality rating system that provides each nursing home a rating of between one and five stars (www. medicare . gov / care - compare). Nursing homes with five stars are considered to have above-average quality, whereas those with one star are considered to have below-average quality. There is one overall one- to five-star rating for each nursing home and a separate rating for each of the following three sources of information.
Health inspections The health inspection rating
contains information from the last 3 years of on-site inspections, including both standard surveys and any complaint surveys. This information is gathered by the surveyors to determine the extent to which a nursing home has met Medicare’s minimum quality requirements. The most recent survey findings are weighted more than the prior 2 years.
Staffing The staffing rating has information about the average number of hours of care provided to each res- ident each day by nursing staff. This rating considers differences in the level of care needed by residents in different nursing homes. For example, a nursing home with residents with more severe needs would be expected to have more nursing staff than a nursing home in which the resident needs were not as great.
Quality measures The quality measure rating has information on 11 different physical and clinical mea- sures for nursing home residents (eg, the prevalence of pressure injuries and substantial weight changes). This information is collected by the nursing facility for all residents. The quality measures offer infor- mation about how well nursing homes care for their residents’ physical and clinical needs.
As with all rating systems, no single system can address every important consideration that goes into
deciding which nursing home may be best for a par- ticular person. Consumers should use this informa- tion, together with other sources of information for the nursing home (eg, visits to the nursing home, local advocacy groups, or the state ombudsman pro- gram), when deciding on placement.
The RDN and the NDTR can play an important part in helping the facility maintain a high star rating by providing sound assessments and implementing interventions that can prevent weight changes, main- tain skin integrity, and improve overall quality of care and quality of life for residents.
Regulations for Group
Homes Group homes are an alternative to larger institutions like assisted-living
referred to as board and care homes or residential care homes.17
facilities. They are sometimes Group homes are licensed by the state, often
with specific state regulations as well, and typically house 5 to 10 people. They offer many benefits in a smaller and more homelike environment. Group homes offer the same basic services as assisted-living facilities and must meet the same state requirements.17 State governments offer searchable or downloadable listings of licensed residential care homes. See Chap- ter 2 for more information about group homes. The federal regulations for group homes are lim- ited to 24 CFR §982.614 (Group Home: Housing Quality Standards).18
The housing quality standards
in 24 CFR §982.401 apply to group homes, and the entire unit must comply.19 housing quality standards.19
Box 22.6 on page 360 lists
Regulations for Assisted-
Living Facilities Assisted-living facilities or communities are regulated by the state governments rather than the federal gov- ernment, often through the state health department or social services office.20
CMS offers guidance to state
Medicaid services regarding rules for facilities that are Medicaid certified, including guidance on issues such
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