At Axis Estate Planning, we understand that selecting a nursing home for a loved one is one of the most emotional and significant decisions a family can face. Many begin their search by turning to the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System. While this system, introduced in 2008, was designed to simplify comparisons between facilities, it has notable limitations—especially as of 2025—that families must consider before relying on it exclusively.
Understanding the Five-Star Rating System
The CMS system provides each nursing home with an overall rating based on three primary components:
- Health inspections
- Staffing levels
- Quality measures (including resident care outcomes)
Although helpful at a glance, these ratings often fail to reflect the full reality of a facility’s performance and care quality.
Why the Star Rating Isn’t Enough
Self-Reported Data Can Be Misleading
Much of the data used to determine star ratings is self-reported by the nursing homes themselves. This includes:
- Staffing levels
- Incident reports
- Resident care metrics
Investigations have found that some facilities:
- Inflate nurse staffing numbers
- Underreport safety issues
- Misrepresent resident conditions and treatments
Inspection Standards Vary Widely
State agencies conduct health inspections, but the quality and consistency of these reviews can differ significantly across state lines. Concerns include:
- Inconsistent inspection protocols
- Advance notice given to facilities before inspections
- Serious violations not being reflected in the overall rating
As a result, a nursing home that appears excellent online may fall short of expectations upon closer inspection.
A Smarter Way to Choose a Nursing Home
At Axis Estate Planning, we advise families to take a more hands-on, investigative approach when evaluating long-term care options:
Tour the Facility
In-person visits allow you to see staff-resident interactions, cleanliness, and the overall environment firsthand.
Ask Thoughtful Questions
Engage with administrators, nurses, and caregivers. Discuss:
- Staff-to-resident ratios
- Emergency procedures
- Dementia care experience
- Employee training and retention
Speak with Current Residents and Their Families
Firsthand accounts from those currently living in or visiting the facility can offer invaluable insights.
Explore Additional Resources
In addition to the CMS website, consult:
- The Michigan Department of Health and Human Services
- Long-term care ombudsman evaluations
- Trusted advisors like doctors and elder law attorneys
Use a Checklist
Bring along tools like the AARP Nursing Home Checklist to help structure your evaluation and avoid missing critical information.
Final Thoughts
The Five-Star Quality Rating System can serve as a helpful initial reference, but it should never be the sole basis for selecting a nursing home. With long-term care becoming a central part of aging in America, it’s essential to go beyond online scores and make decisions grounded in observation, research, and guidance.
If you’re facing long-term care decisions or need help protecting a loved one’s future, Axis Estate Planning is here to provide clarity, support, and trusted legal guidance every step of the way.
Visit Us: 900 Wilshire Drive, Suite 105, Troy, MI 48084
Call Us: (248) 251-1001
Learn More: www.axisattorneys.com
Axis Estate Planning
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