At Duncan Legal, PC, we understand how emotional and overwhelming it can be to choose a nursing home for a loved one. Families often begin the search with the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System—a tool created in 2008 to help consumers assess the quality of nursing homes at a glance. But as of 2025, this system has shown serious limitations that should give families pause before relying on it exclusively.
The Five-Star Rating System: What It Measures
The CMS rating is based on three major components:
- Health inspections
- Staffing levels
- Quality measures (such as resident health and care outcomes)
While this system was intended to simplify evaluations, it often fails to reflect the complete picture.
Why the System Falls Short
Self-Reported Data Can Be Inaccurate
Many of the figures that factor into a nursing home’s star rating come directly from the facility itself. These include:
- Staffing levels
- Safety and incident reports
- Resident condition documentation
Research has uncovered several concerning trends:
- Some facilities report inflated nurse staffing numbers
- Others underreport safety violations
- Records may not accurately reflect the use of medication or level of resident care
Inconsistent Inspections
Health inspections are another critical component of the rating. However, they are conducted by individual state agencies, which leads to inconsistencies. Some issues include:
- Varying standards across states
- Advance notice of inspections, allowing temporary improvements
- Serious infractions not always being reflected in the final score
At Duncan Legal, PC, we believe families deserve better than surface-level information when making decisions about long-term care.
A Better Approach to Evaluating Nursing Homes
Choosing a nursing home requires thoughtful, first-hand evaluation. We recommend a proactive, multi-step process:
Visit the Facility in Person
Observe the cleanliness, staff attentiveness, and resident interactions. A walk-through can reveal far more than an online rating ever could.
Ask the Right Questions
Speak with staff and administrators. Key areas to explore include:
- Staff turnover
- Emergency procedures
- Experience with memory care and dementia
- Daily routines and medical protocols
Talk to Families and Residents
Hearing directly from those living in the facility—or their loved ones—offers invaluable insight.
Use Additional Resources
Beyond CMS ratings, consult:
- Your state’s Department of Health inspection records
- Reports from long-term care ombudsman programs
- Recommendations from doctors, elder care coordinators, or legal professionals like Duncan Legal, PC
Bring a Checklist
Tools like the AARP Nursing Home Checklist can help you keep track of important criteria during visits.
Why Legal Guidance Matters
As care needs increase, so do the legal implications. From protecting assets to ensuring proper authority through powers of attorney or health directives, early legal planning is key. At Duncan Legal, PC, we help families understand their rights and options so they can make informed, empowered decisions.
Final Thoughts
The CMS Five-Star Quality Rating System may be a useful starting point, but it should never be the only tool you use. A hands-on approach combined with trusted professional guidance helps ensure your loved one receives the care and dignity they deserve.
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Duncan Legal, PC
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