Association Between Nursing Home Five-Star Ratings and Consumer Satisfaction

Abstract

Objective: Consumers can currently access the Centers for Medicare and Medicaid Services Five-Star Quality Rating System when they choose a nursing home (NH). However, the system does not incorporate NH consumers' opinions. Without having access to satisfaction or quality-of-life measures, consumers could make uninformed decisions. This study aims to investigate the association between five-star ratings and family/resident satisfaction scores.

Design: Secondary data analysis was used.

Setting and participants: A unique, NH-level dataset of Ohio NHs that contains star ratings, satisfaction scores, and NH characteristics was constructed (N = 701). Data were drawn from the 2018 star rating data, 2018 Ohio Nursing Home Family Satisfaction Survey, 2017 Ohio Nursing Home Resident Satisfaction Survey, 2017 Ohio Biennial Survey of Long-Term Care Facilities, and the Certification and Survey Provider Enhanced Reports.

Methods: Chi-square and logistic regression analyses were conducted controlling other NH characteristics.

Results: Chi-square results showed consumer satisfaction and star ratings were correlated, but imperfectly related. Regression results found that NHs with higher family satisfaction score received significantly higher star ratings across all domains except the quality-measure star rating. For each 1% point increase in the family satisfaction score, the probability of being a 4 or 5 overall star NH increases by 1.1% point (P < .01), and being a 4 or 5 health inspection star NH increases by 1.2% points (P < .01). NHs with higher resident satisfaction score received significantly higher star ratings. For every 1% point increase in the resident satisfaction score, the probability of being a 4 or 5 star NH increases by 0.7% point (P < .05) across all star ratings.

Conclusions and implications: Early studies found little relationship between five-star ratings and consumer satisfaction scores. This study found consumer satisfaction is associated, although imperfectly, with star ratings. This highlights the need to publicly report NH consumer perspectives to help them make informed care decisions.

Keywords: Centers for Medicare and Medicaid Services (CMS); Long-term services and supports; family satisfaction; nursing homes; quality of care; quality of life; resident satisfaction.