Nursing Home Quality in Maryland

Maryland

In 2023, there were 1.2 million residents living in approximately 15,000 nursing homes across the United States. Older adults usually move to a nursing home when they develop cognitive, mental or functional impairments that make it difficult to complete day-to-day tasks. A landmark study published by the Institute of Medicine in the late 1980s cited the urgent need for better regulatory standards in nursing homes to accommodate a growing older adult population. Subsequent reports have highlighted recurring problems with low staffing and elder abuse in nursing homes, which contribute to poor health outcomes such as depression among nursing home residents. Quality nursing home practices, such as fall management and risk prevention, may help reduce adverse health outcomes and high medical costs.

The Centers for Medicare & Medicaid Services (CMS) added the Five-Star Quality Rating System to its Nursing Home Care Compare tool in 2008. More stars indicate the nursing home is rated higher in quality. The ratings are a composite score based on health inspections, quality of resident care and overall staffing. The public ratings are intended to encourage nursing homes to achieve higher quality.

Nursing homes with higher ratings include:

• Smaller nursing homes with fewer beds (<60) compared with larger nursing homes with more than 120 beds.
• Nursing homes affiliated with a continuing care retirement community.
• Nonprofit nursing homes compared with for-profit nursing homes. 
• Nursing homes in states that have a smaller proportion of low-income older adults. 

One study found that nursing homes with three or fewer stars were concentrated in southern states. Moreover, the quality of nursing home care is lower in areas with a high concentration of racial and ethnic minorities.

The Five-Star Quality Rating System can help individuals and families select the right nursing home for themselves and their loved ones. Information is available from CMS’ new Care Compare tool, which combines its eight distinct provider comparison metrics into a single interface. CMS also authored a guide to finding and comparing nursing homes and other long-term care services, which includes a checklist individuals can use to evaluate the quality of a nursing home during a visit.

CMS is constantly improving their standards for nursing home quality. In 2019, CMS announced a new component for reporting elder abuse and removed pain quality measures from their model to avoid the possibility of incentivizing overprescription of opioids. 

While overall nursing home quality has been improving, there has been concern regarding the reliability of using self-reported data for nursing home ratings. The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 now mandates and standardizes reporting from nursing, rehabilitation and long-term care facilities in order to ensure their Care Compare data is high-quality and comparable across facilities.

Boccuti, Cristina, Giselle Casillas, and Tricia Neuman. “Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State.” Issue Brief. KFF, May 14, 2015. https://www.kff.org/report-section/reading-the-stars-nursing-home-quality-star-ratings-nationally-and-by-state-issue-brief/.

Gallagher, Lani G. “The High Cost of Poor Care: The Financial Case for Prevention in American Nursing Homes.” Washington, D.C.: The National Consumer Voice for Quality Long-Term Care, 2011. https://theconsumervoice.org/uploads/files/issues/The-High-Cost-of-Poor-Care.pdf.

Harrington, Charlene, Mary Ellen Dellefield, Elizabeth Halifax, Mary Louise Fleming, and Debra Bakerjian. “Appropriate Nurse Staffing Levels for U.S. Nursing Homes.” Health Services Insights 13 (January 2020): 117863292093478. https://doi.org/10.1177/1178632920934785.

Harrington, Charlene, Joshua M. Wiener, Leslie Ross, and MaryBeth Musumeci. “Key Issues in Long-Term Services and Supports Quality.” Issue Brief. KFF, October 27, 2017. https://www.kff.org/medicaid/issue-brief/key-issues-in-long-term-services-and-supports-quality/.

Institute of Medicine Committee on Nursing Home Regulation. Improving the Quality of Care in Nursing Homes. Washington, D.C.: National Academies Press, 1986. http://www.nap.edu/catalog/646.

Shippee, Tetyana P., Weiwen Ng, and John R. Bowblis. “Does Living in a Higher Proportion Minority Facility Improve Quality of Life for Racial/Ethnic Minority Residents in Nursing Homes?” Innovation in Aging 4, no. 3 (May 1, 2020): 1–9. https://doi.org/10.1093/geroni/igaa014.

Yuan, Yiyang, Christopher Louis, Howard Cabral, Jeffrey C. Schneider, Colleen M. Ryan, and Lewis E. Kazis. “Socioeconomic and Geographic Disparities in Accessing Nursing Homes With High Star Ratings.” Journal of the American Medical Directors Association 19, no. 10 (2018): 852-859.e2. https://www.sciencedirect.com/science/article/abs/pii/S1525861018302895.