To achieve and maintain both the quality and the smooth operation of nursing homes, the U.S. government implemented a scoring system. Like the star system for hotels, nursing homes for older adults with better attendance and effective treatments score higher, five stars. The GAO, which verifies the management and administration of the resources of the federal government, analyzed the program.

The report published this year by the U.S. entity equivalent to our National Audit Office says that the system "can provide valuable information to consumers and improve the quality of nursing homes." In fact, those who do not provide sufficient information are not evaluated and therefore don’t appear in the ranking of nursing homes, or as an institution available to patients.

In 2010, it was instructed that the Centers for Medicare & Medicaid Services, CMS an agency under the aegis of the Ministry of Health, develop a quality measurement program that is applicable to all public nursing homes. This qualifies by awarding stars to the centers (one to five stars) according to three attributes, which grouped 33 "functioning" factors. It should be noted that the data results from health inspections, staffing, and measures of service effectiveness.

The GAO notes that the benefits are not just for patients but also for insurance companies. This is because as patients receive more personalized and preventive care, doctor visits and diseases decrease. Thus, the costs the health insurance company would have had are significantly reduced. According to the Congressional Budget Office, companies are saving billions of dollars from preventive care. Meanwhile, the homes who get four or five stars annually receive financial compensation as an incentive to improve the quality and transparency of information.

What Is Taken Into Account?

Factors considered by the CMS are grouped into three attributes: the measurements of effectiveness, quantity, and quality of staff and health inspections. The results of these measurements are published annually and are available before the registration dates open. Thus, future patients may make a decision based on relevant information, and choose the setting that best suits their needs.

Sanitary Inspections

Information gathering is done with data from the last three years of evaluations made by previous health inspectors, complaints by relatives of the patients or the patients themselves, the frequency of checkups, vaccinations, and control of chronic diseases, including 180 control points. On a national level more than 200,000 visits are performed.

Even though the way of doing the evaluation is standardized, it sometimes varies by state. According to the GAO, this hinders the realization of national and equitable scores. Therefore, CMS advises patients to compare homes within the same state.

Quantity and Quality of Staff

Within this aspect it is considered the average number of hours that nurses devote to each patient per day. It should be noted that the collection of personal information is made internally by the same nursing home, and not by an independent agency.

Measurements of Effectiveness 

To analyze the effectiveness of a nursing home, it is taken into account the measurement of 10 physical illnesses and clinics. . For example, one of the measurements is to know how effective the nurses are in curing skin afflictions. There are currently about 12 million assessments of conditions of patients in geriatric care centers. However, this aspect has also been criticized because it is made by the institution itself and not by a third party.

What GAO Recommends

According to the federal watchdog, the system needs a strategic plan, which will help establish long term objectives in order to achieve greater transparency from suppliers. Finally, CMS responded to the report with appreciation, agreeing to implement the recommendation.