Reading a state inspection report and the Medicare star rating without a decoder ring

Two places to look

NYS Health Profiles is the state's own site. It covers adult homes and assisted living residences, nursing homes, home care agencies, and hospices, with inspection results, complaint findings, and enforcement actions, and it lets you compare facilities side by side. Medicare Care Compare is the federal site. For nursing homes and home health agencies it adds star ratings, staffing data, and quality measures. Adult homes and assisted living are not on Care Compare because Medicare does not certify them.

What an inspection is

The state sends inspectors, usually unannounced, to check a community against the regulations. For nursing homes that participate in Medicare or Medicaid this comprehensive survey happens about once a year, plus visits to investigate complaints. Each problem found is written up as a deficiency or citation with a description of what happened. The community then submits a plan of correction. Reading three or four citations tells you more than the count does.

How to read a citation

• Read the narrative, not just the code. It usually describes one resident and what went wrong.
• Notice scope and severity. Federal surveys grade each finding by how many residents were affected and how much harm was done or could have been done. One serious finding matters more than five paperwork ones.
• Look for patterns across years: the same kind of problem in each survey suggests a system problem, not a bad day.
• Look at complaint investigations separately. A substantiated complaint about abuse or neglect deserves a direct question on the tour.
• Check enforcement actions. Fines and admission bans are listed on both sites.
• Ask the community what changed. A good administrator will know each citation and what they did about it.

The five stars, in plain words

Medicare's overall rating for a nursing home is built from three separate ratings, each with its own stars.

• Health inspections: based on the number, scope, and severity of problems found in the three most recent annual surveys and in complaint investigations over about three years. This rating compares nursing homes within the same state, so a New York three-star is being compared to other New York homes.
• Staffing: nurse and aide hours per resident per day, including registered nurse hours, adjusted for how sick the residents are.
• Quality measures: how residents fare on things like pressure sores, falls with injury, use of antipsychotic medicines, and return trips to the hospital, taken from the clinical data every home reports.
• The overall star starts from the inspection rating and moves up or down a star for very high or very low staffing and quality ratings. So a home with strong staffing can carry a weak inspection year, and the reverse.

What the stars cannot tell you

Medicare itself says the ratings are meant to be used with other information and cannot substitute for a visit. Stars lag; a home can change owners or a director of nursing and be a different place within months. Staffing numbers are reported by the home. And no rating measures whether residents look happy or whether an aide kneels to speak to your mother. Use the report to write your questions, then go look.

For home care and hospice

Care Compare rates home health agencies and lists hospice survey results and family survey scores. NYS Health Profiles lists every licensed home care agency and hospice with its inspection history. The same reading rules apply: narrative over numbers, patterns over single events.

If something on a report worries you

Ask the community first. Then, if you want an independent view, the Long Term Care Ombudsman Program is free and confidential. Complaints about care go to the state: 1-866-893-6772 for adult homes and assisted living, 1-888-201-4563 for nursing homes, 1-800-628-5972 for home care and hospice.