Description of factors used in star ranking

Resident satisfaction/quality of life ratings
Resident satisfaction and quality of life interviews are conducted in all nursing facilities. The interviews are planned to continue on an annual basis. Trained interviewers employed by an independent contractor of the State interview a sample of residents in each facility. The number of interviews completed in each facility will vary based on the number of eligible residents in the facility. A standardized interview is used in all facilities and measures resident satisfaction and quality of life for a variety of topics including; comfort, environmental adaptations, privacy, dignity, spiritual well-being, meaningful activity, food enjoyment, autonomy, individuality, security, relationships and mood. A facility with 5 stars has received the highest rating from the perspective of the residents in that facility. Click here to view rating questionnaire (PDF: 327kb/4 pages)

Minnesota quality indicators
During their stay in a nursing home, residents are assessed by the facility staff. This is called a Minimum Data Set assessment (MDS) and is performed at admission, quarterly, annually and whenever the resident experiences a significant change in status. This extensive assessment includes many items such as: diagnoses; the ability to do activities of daily living (ADL) such as getting in and out of bed, walking, eating, bathing, toileting, etc; clinical conditions such as the presence of sores, wounds or cuts on the body; use of certain types of medications; dehydration; mental functioning; and certain cares and treatments provided to the resident.

Selected items from the MDS have been identified as potential indicators of the quality of care provided to the resident. The report card currently uses 15 quality indicators, listed in Table 1, to calculate the Quality Indicator score (Stars). These quality indicators have been risk adjusted to account for differences between the types of residents served in nursing homes. Examples of the adjustors used are, but are not limited to: age, gender, cognitive performance (mental functioning), Alzheimer�s disease, stroke, and ADL ability. Facilities performing at the highest level compared to other facilities in the state will receive 5 stars. Facilities performing at the lowest level compared to other facilities will receive one star.

A clinically updated version of the assessment form, the MDS 3.0, was introduced on October 1, 2010. Because of this change, several indicators that cannot be calculated have been discontinued but there is exciting potential for new and/or improved indicators. DHS in collaboration with MDH will include these additional indicators later in 2011.

Facility average (mean) direct care hours per resident day are based on annual statistics provided by the nursing facility and are subject to audit by the Department of Human Services. Direct care hours include all staff providing direct care to residents, e.g., nurses, social workers, and activity staff. Staffing hours per resident day are weighted for relative cost per staff type (salary ratios) and adjusted for the facility's average case mix. Case mix is a means of classifying care that is based on the intensity of care and services provided to the resident. Hours per resident day are adjusted for salary ratios and case mix to allow for a more meaningful comparison between facilities. All nursing homes in the state are grouped into three types of facilities for purposes of comparing staffing levels. The three groups are generally described as: 1) Hospital-attached, Rule 80 and those facilities with frequent new admissions; 2) Boarding care homes or a facility with more than 50%of their beds licensed and certified as Board and Care; and 3) all other regular free-standing nursing facilities.

The staff retention rate calculation is based on the number of direct care employees on 10/1 of one year that were still employed on 9/30 of the following year divided by the number of direct care employees. The retention rate is computed using data reported by the nursing facility on an annual statistical report and is subject to audit by the Department of Human Services.

On an annual basis, the average percentage of pool staff (temporary staff hired from a staffing agency) is calculated for those facilities reporting any pool use. A facility will earn five stars if they do not use any pool staff or a very minimal percentage (less than ½ percent) of their hours are filled by temporary staff. A facility will be assigned one star if their pool use equals 4 percent or more of their total nursing hours.

Proportion of single rooms
This is a measure to report the proportion of all beds in the facility in single rooms. A facility will earn five stars if their percentage of private/single rooms equals 90 percent or more of their beds. A facility with less than 15 percent of private/single rooms will be assigned one star.

All deficiencies cited are issued with reference to a scope and severity (see Table 2 below).  Scope refers to how widespread the problem is, and can be isolated, patterned, or widespread.  Severity ranges from no actual harm with a potential for minimal harm to situations of actual harm and immediate jeopardy to resident health or safety.

The state inspection measure is based on the following five criteria. 

1. If the facility’s most-recent available health and life-safety code survey had actual harm, substandard quality of care, or immediate jeopardy
2. If the facility had a confirmed complaint or facility self-report of actual harm, substandard quality of care, or immediate jeopardy over the past year
3. If the facility’s prior health survey had substandard quality of care or immediate jeopardy
4. If the facility is on the Special Focus list of providers judged by MDH and the federal Centers for Medicare and Medicaid Services as needing additional oversight
5. If the facility has a high number of health deficiencies, defined below

The state inspection measure judges a nursing home’s performance to be OK or not OK on these criteria, which are combined for the following star ratings:

5 Stars Most-recent available survey OK
             Prior survey OK
Record on complaints and facility self-reports OK
             Not a Special Focus facility
             Not a high number of health deficiencies

4 Stars Most-recent available survey OK
             Record on complaints and facility self-reports OK
             Not a Special Focus facility

3 Stars Most-recent available survey OK, allowing ONE isolated instance of actual harm
             Record on complaints and facility self-reports OK

2 Stars  Most-recent available survey not OK
             Record on complaints and facility self-reports OK
             OR
             Most-recent available survey OK, allowing ONE isolated instance of actual harm
             Record on complaints and facility self-reports not OK

1 Star   Most-recent available survey not OK
             Record on complaints and facility self-reports not OK

Here are some key terms used in this measure:

Actual harm includes any deficiency citation where actual physical or emotional harm to a resident has been identified.  Harm can occur in any citation with a scope and severity level “G” through “L.” (Guidance on scope and severity determination is provided in Appendix P; section IV.B and IV.C of the CMS state operations manual).

Substandard quality of care means one or more deficiencies related to participation requirements under 42 CFR 483.13, resident behavior and facility practices, 42 CFR 483.15, quality of life, or 42 CFR 483.25, quality of care, that constitutes either immediate jeopardy to resident health or safety, a pattern of or widespread actual harm that is not immediate jeopardy, or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm (Defined in the CMS state operations manual chapter 7, section 7001).

Substandard quality of care includes any health deficiency (called F-tags) in Table 3 below that is of a scope and severity of “F” or higher but not equal to “G” (as “G” represents isolated and not patterned harm).

Immediate jeopardy means a situation in which the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident (Defined in the CMS state operations manual chapter 7, section 7001).

Special Focus Provider is a nursing home deemed by the Department of Health and the Centers for Medicare and Medicaid Services to be performing at a level where additional oversight is needed to assure compliance with government regulations.

High number of deficiencies means that the total number of deficiency citations issued to a facility on the most-recent available health survey is less than the average of high statewide and high survey district deficiencies, determined by the following formula: