Trump Administration Enhances Transparency about Abuse and Neglect Five-Star Update

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Today, October 7, 2019, CMS announced “a major enhancement of the information available to nursing home residents, families, and caregivers on the Agency’s Nursing Home Compare website”.

Later this month, CMS will – for the first time – display a consumer alert icon next to nursing homes that have been cited for incidents of abuse, neglect, or exploitation. By making this information accessible and understandable, CMS is empowering consumers to make the right decisions for themselves and their loved ones. This critical move toward improved transparency is yet another way CMS is delivering on the Agency’s five-part approach to ensuring safety and quality in nursing homes, which Administrator Seema Verma announced in April 2019.

“The Trump Administration and CMS are committed to ensuring that nursing home residents are safe from abuse and neglect. Through the “transparency” pillar of our five-part strategy to ensure safety and quality in nursing homes, we are giving residents and families the ability to make informed choices,” said Administrator Seema Verma. “With today’s action, the Trump Administration is putting critical information at consumers’ fingertips, empowering them and incentivizing nursing homes to compete on cost and quality.”

The already robust Nursing Home Compare tool displays an array of information about nursing homes – including whether a facility meets federal standards with respect to health and safety compliance inspections, staffing levels, and quality measure performance. Previously, consumers could learn about past instances of abuse citations at a nursing home, but finding this information from its health inspection reports available on Nursing Home Compare required multiple steps. Through today’s action, CMS is minimizing the steps, making it easier than ever for patients, residents, and their families and caregivers to quickly identify nursing homes with past citations for abuse.


Patients and families will see CMS’ new alert icon for Nursing Home Compare, shown above.

Beginning October 23, 2019, the new alert icon will be added to the Nursing Home Compare website for facilities cited on inspection reports for one or both of the following: 1) abuse that led to harm of a resident within the past year; and 2) abuse that could have potentially led to harm of a resident in each of the last two years. To ensure CMS is providing the latest information, the icon will be updated monthly, at the same time CMS inspection results are updated. This means consumers will not be forced to wait for CMS’s quarterly updates to see the latest -related information – and nursing homes will not be flagged for longer than necessary if their most recent inspections indicate they have remedied the issues that caused the citations for abuse or potential for abuse and no longer meet the criteria for the icon. This icon will supplement existing information, including the Nursing Home Five-Star Ratings, helping consumers develop a more complete understanding of a facility’s quality.

There are many factors that indicate a nursing home’s quality, and the Star Ratings may not capture some nuances. For example, a nursing home cited for an incident of abuse may have adequate staffing numbers and provide excellent dementia or rehabilitative care. Previously, consumers would clearly see this facility’s performance in these areas through the Star Ratings, but abuse complaint allegation information may not have been as clear. Under the CMS action announced today, this facility would have an alert icon displayed, allowing consumers to see both its Star Ratings and the icon, helping them easily weigh the facility’s quality. In addition, we are continuing our work to improve the usefulness of the Star Ratings.

Today’s announcement is part of CMS’ larger push initiative to keep nursing home residents safe – Administrator Verma’s  five-part approach to ensuring safety and quality in America’s nursing homes. The approach includes the following pillars: Strengthening Oversight, Enhancing Enforcement, Increasing Transparency, Improving Quality, and Putting Patients over Paperwork. This framework is informing all CMS work related to nursing home safety.”

The updated Five-Star Technical User’s Guide provides these revisions:

“In October 2019, several changes will be made to the Nursing Home Compare website and the Five-Star Quality Rating System. These changes will affect the health inspection and quality measure domains. This section provides details on these changes.

Ratings changes for facilities that receive the abuse icon: To make it easier for consumers to identify facilities with instances of non-compliance related to abuse, starting in October 2019, CMS is adding an icon to highlight facilities that meet either of the following criteria:

1) Harm-level abuse citation in the most recent survey cycle: Facilities cited for abuse where residents were found to be harmed (Scope/Severity of G or higher) on the most recent standard survey or on a complaint survey within the past 12 months.

2) Repeat abuse citations: Facilities cited for abuse where residents were found to be potentially harmed (Scope/Severity of D or higher) on the most recent standard survey or on a complaint survey within the past 12 months and on the previous (i.e., second most recent) standard survey or on a complaint survey in the prior 12 months (i.e., from 12 to 24 months ago).

Nursing homes that receive the abuse icon will have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that has received the abuse icon can have is four stars.

Removal of quality measures related to pain: CMS will be removing two quality measures (QMs) from the Nursing Home Compare website and the Five-Star Quality Rating System in October 2019. These measures are:

  • Percentage of short-stay residents who report moderate to severe pain. • Percentage of long-stay residents who report moderate to severe pain.

As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings will change starting in October. These changes will be made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. The new cut-points are shown in the table below. Note that this table will replace Table 6 in the Technical Users’ Guide (TUG) starting after these changes are implemented in October 2019.”


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