Star rating system: Expedia for nursing homes?

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Yes, you too could be the Four Seasons of nursing homes.

As we all know by now, the Centers for Medicare & Medicaid Services plans to create a five-star quality rating system for facilities (see stories on the McKnight's home page from Wednesday and Thursday). The system, whose metrics are still being refined, will appear on the consumer-oriented Nursing Home Compare Web site ( by year's end.

I don't know about you, but the first thought that came to my mind when I heard about the plan was hotels. After all, when most of us choose accommodations we go to a Web site like or to see first-hand visitors' opinions. Will it be any different for nursing homes? You could either be a first-class, chocolate-on-the pillow type of joint, or a lowly two-star, where the pool is more of a pond?

But the comparison only goes so far. The reason is, and I hate to break it to everyone, but nursing homes aren't hotels. They aren't washing machines or any other kind of commodity that consumers judge by scores either.

Unlike those resorts in Puerto Vallarta, nursing homes aren't taking care of honeymooners. Rather, the guests are vulnerable, high-acuity residents, and many don't want to be there.

Granted, families want to know more about the nursing homes where they are sending their parents. And they should have as much information as possible. Transparency is a good thing. If you shop on Nursing Home Compare today you'll learn a lot of objective information about a facility, such as its number of beds, the number of nurse staffing hours, and the results of its last survey, including details about deficiencies.

Adding a ratings system, while a customer-oriented measurement, may be setting consumers up for disappointment. A five-star nursing home, unlike its counterpart in the hospitality industry, will not have bronze beachcombers lounging by the pool. There likely will be a resident or two slumped in her chair when a visitor arrives, and there could be unpleasant sounds and smells wafting through the hallways.

But the ratings system isn't necessarily a bad idea either—if nursing homes get their fair shake-such as figuring residents' and families' satisfaction scores into the mix.

And there could be upsides. How about this recommendation for CMS? More Medicare and Medicaid funding for five-star facilities.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.