Q: What is the Medicare Five-Star Rating System for Nursing Homes?

A: Many elderly adults have their first encounter with a skilled-nursing facility after a sudden health event and hospitalization. A hospital discharge planner arranges for transfer to a skilled-nursing facility, but that facility may be far from family and may not provide the best care. To that end, Medicare launched the Five Star Quality Rating as a way to improve consumers' understanding of nursing home quality.

Medicare uses three factors for rating: the inspections for the previous three years, including number of complaint surveys and follow-up inspections; the type and amount of nursing staff; and quality measures of care, including pressure ulcers, falls with significant injury, reports of pain, and the number of people who receive antipsychotic medications.

There are limits to this rating system. For example, facilities gather staffing information only once a year, over two weeks, meaning there may not be consistency over the rest of the year. There may also be differences in perceived quality issues between an inspector and a nursing home resident. Nursing staff turnover, an important measure of quality, is also not included in the rating.

Be an informed consumer. Visit Medicare.gov and click on the "Nursing Home Compare" tab. There, you can enter the name of a facility and see how it measures up to others in your area. Visit local facilities and observe how the staff interacts with residents, the smell, the amount of unanswered calls or alarms, and how residents enjoy the food. If physical rehabilitation is needed, explore the rehab facility. If a loved one has confusion or dementia, ask what kinds of activities are offered that can help. And ask about nursing turnover rates. More than 50 percent may indicate the facility has an inadequate number of experienced staff.

Ilene Warner Maron, Ph.D., codirects the M.S. program in aging and long-term care at the Philadelphia College of Osteopathic Medicine.