Five-Star Rating: Constructive Re-Alignment

December 30, 2008

The following is a comment to my post titled: Five Star Rating Techincal Manual: Staffing Domain Accuracy.

I copy it here becuase the author makes a very good point w/r/t where the focus should be for Nursing Home Administrators, and I wouldn’t want it to get lost:

“As a member of the Technical Advisory Panel for the 5-Star system and a co-author of the paper cited in this discussion, I am in a relatively unique position to comment. The author of the posting is correct about the potential effects of errors in reporting staffing.

However, the study showed that for-profit homes tend to over-report, and it was for-profit homes that fared the worst in the 5-Star system. So, it seems that the effects of over-reporting may not be as dire as suggested.

In addition, I would suggest that instead of trying to cast doubt on the 5-Star system, which we all admit is not perfect, the industry should push for a new reporting system for staffing. That is what NCCNHR is doing. Join them. After all, the staff data are self-reported by homes. If your fellow administrators are “cheating you,” then I suggest that you advocate a reporting system that doesn’t allow them to do that.”

To Dr. Phillips I say, yes, you are absolutely right to point out that the energy should not be soley on casting doubt on the Five-Star system, but instead should be focused on the constructive work of fixing the public rating system as a whole.  The Five Star data just makes more accessible the already flawed Nursing Home Compare data.  Therefore, it is important to focus the anger we feel at being “cheated” by an innacurate  system into 1) convincing the public and legislators that this is a poor tool for researching nursing homes and 2) helping to devise a new system.  We must be careful of doom and gloom predictions and overactions like calling the Five-Star system a “travesty of justice,” as Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging said to members of Dec. 18th.

On a personal note, though, I still find my blood pressure rises when I think about how the quality of care I know my home provides is not as well reflected as I think it should be in its Five-Star rating.  Maybe the advice from older DONs than Directors of Nursing is appropriate here: (in Latin) “pace. pace. pace (peace. peace. peace.)”.  Let’s take a breath and work the problem instead of rail at it.


3 Responses to “Five-Star Rating: Constructive Re-Alignment”

  1. rodmackenzie Says:

    We are currently looking to set up nursing discussion groups when our board visit the united states in March 2009 about the topic of retirement villages over standard nursing homes. If you are interested in participating my email is

    Many Thanks

    Rod Mackenzie

    • nursinghomeadministrator Says:

      Thank you for your comment. I would be happy to participate in such a discussion group.
      I have sent you message to the email address listed.

  2. Charles D. Phillips Says:

    No performance measurement system can tell the entire tale. The MDS, which I helped develop back in late 1980s, does not have a place on it to record kindness, caring, respect, and the “acts of grace” that occur on a daily basis in good homes. That must be done elsewhere (and I don’t really believe it’s done in the satisfaction surveys so popular today).

    But, I think your last statement is the crux of the entire matter. “Let’s take a breath and work the problem instead of rail at it.” That is the attitude that will move the process of performance measurement forward.

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