Neighbors surpass Mass. in nursing home ratings

The federal Centers for Medicare & Medicaid Services rated nursing homes based on state health inspections, staffing, and quality-of-care measures. The findings were combined in an overall rating,with one star indicating "much below average" and five stars indicating "much above average." (Globe Staff Graphic / Daigo Fujiwara)

A new government ranking system for nursing homes nationwide shows that Massachusetts has fewer top-notch rated facilities, and more ranked below average, than New England neighbors Connecticut, New Hampshire, and Maine.

The ratings, unveiled yesterday by the US Centers for Medicare & Medicaid Services, rates nursing homes on a star system - from one to five stars, with five stars the best - based on state health inspections, staffing, various quality-of-care measures, and a final score for overall quality.

Some 16.6 percent of nursing homes in Massachusetts earned top scores for overall quality, while next door in New Hampshire, 24.4 percent made the grade. The only New England state with a lower percentage of top-ranked homes than Massachusetts was Rhode Island, with 14.1 percent.

The Bay State also had a higher percentage of "one-star" nursing homes than did any other New England state but Vermont.

Overall, Massachusetts facilities did better than the national average in both categories of top-ranked and bottom-ranked nursing homes.

The rating system, called Nursing Home Compare, rates approximately 16,000 nursing homes, including 433 in Massachusetts. It allows consumers to easily sort through reams of data on health inspections, staffing levels, even the percentage of patients who had bed sores or were physically restrained.

Given how complex and overwhelming the process of choosing a nursing home can be, Kerry Weems, the agency's acting administrator, said the new ranking system "should help consumers in narrowing their choices," adding that "nothing should substitute for visiting a nursing home in making their choices."

Despite the Bay State's relatively low scores compared with most of its New England neighbors, Massachusetts ranked well when viewed nationally, said Paul Dreyer, director of the state's Division of Health Care Quality, which oversees nursing homes. Dreyer pointed out that Massachusetts ranked 10th in the country among states with the highest percentages of facilities with five-star ratings, and number one among the 13 states with 400 or more nursing homes.

The national rankings use survey reports from state and federal health inspectors.

The trade association that represents most of the state's nursing homes said the national data, while more understandable than other ranking systems, still does not give consumers a full picture of the various facilities.

"If you are a consumer, and you want to find the best place for Alzheimer's care, there are some really important questions you should ask that will not be in that five-star system, such as, is the staff specially trained for Alzheimer's care," said Alice Bonner, executive director of the Massachusetts Senior Care Association.

"Measuring quality in health care, whether it's hospitals or nursing homes, has been an elusive goal because it's very complicated," she said. "There are many different factors that go into quality and figuring how to assign stars or numbers that accurately reflect what is out there in the real world."

Several consumer groups applauded the government's new ranking system for its consumer-friendly approach, but criticized the agency for relying too heavily on data that is self-reported by the nursing homes, such as the staffing ratios and the quality measures, including the use of restraints and the frequency of urinary tract infections.

In Washington, D.C., the National Consumer Voice for Quality Long Term Care said in a statement that self-reported data is "widely recognized as unreliable," particularly with staffing and quality-of-care issues. The group is calling on the agency to instead collect staffing data from electronic payroll records, which would reflect audited numbers of staff turnover and retention rates, "important indicators of nursing home quality."

When measured by staffing ratios, the percentage of Massachusetts nursing homes earning top scores is lower than all of its New England counterparts, except Vermont. But the state did earn more top rankings for staffing, compared with the national average.

The ranking system is still a work in progress, officials said. The ratings are available at www.medicare.gov.

Kay Lazar can be reached at klazar@globe.com