OGD: Medicare data shows trouble spots for nursing homes


A couple of weeks ago we looked at one Florida nursing home  to see what available government data could tell us about the quality of care. Today we’ll take a look at what the Centers for Medicare and Medicaid Services (CMS) data can tell us about nursing homes throughout the nation as a whole.

A few well-respected researchers (such as Charlene Harrington and her colleagues at the University of California, San Francisco) have tackled these questions in depth, but reporters can still glean useful nuggets through their own quick and dirty analysis.

We used the Nursing Home Compare data at data.medicare.gov to look at the average number of “deficiencies,” as surveyors refer to violations of federal health and safety standards, per home. In 2009, the average number of violations varied widely, from a mere 4.6 per home in Rhode Island to 23.8 per home in the District of Columbia (which, unfortunately, was too small to appear on our map).

(Note: Dark colors indicate MORE deficiencies.)

We also looked at staffing levels, a key indicator of the quality of care that nursing home residents receive. CMS awards each home between one and five stars based on how many registered nurses (RNs) are available to patients. (RNs are the most highly-trained and can administer medication).

Some states have, on average, much better-staffed homes than others. Louisiana’s nursing facilities, for example, received an average of only 1.6 stars based on the number of RNs per patient; each of Alaska’s homes got five. The following ratings were assessed at each home’s most recent survey, within the last year and a half.

(Note: Dark colors indicate HIGHER ratings.)

(Note: The District of Columbia doesn’t appear on the map, but its average rating for RN staffing was 3.1.)

There are a couple of important caveats to consider when viewing this data. When comparing states’ performances, keep in mind that the surveying agencies at some states are better staffed than others, have better training budgets, and may be better equipped to investigate and find problems. This can affect the comparative performance of homes in different states.

Staffing data should also be taken with a grain of salt because the ratings are based on data that is currently self-reported. This is due to change within the next couple of years as health care reform goes into effect.

Other factors that can affect the number of registered nurses in a facility include the size of the nursing homes in a state (smaller homes tend to have better ratios) and whether a majority of the homes are part of a hospital rather than stand-alone facilities. Alaska’s homes, for instance, have very good ratings on staffing. This might be because the state’s 15 homes have the fewest residents on average (41.6), and may also be because 11 of the 15 are located within hospitals.