The staffing domain is also subject to the self-report criticism faced by the quality domain. Research has backed these beliefs, identifying variability between facilities in the way that MDS resident assessments are completed as well as the presence of potential issues with the risk adjustment performed on the data ( Mor, 2005). Nursing home administrators argue that variations in data coding, unaccounted differences in case mix, and unusual events affect performance on these quality measures ( Mukamel et al., 2007 Rahman & Applebaum, 2009). Within the quality domain, the primary concern is that the data are based on the MDS, which is collected and submitted by nursing home staff. When examining variations in inspection data, a recent study found that different survey districts within states also had variability beyond what could be explained simply by regional variations in quality ( Miller & Mor, 2008). More recently, a study comparing CMS federal surveys to state inspections found that 7 in 10 state surveys missed at least one deficiency citation the average number of deficiencies missed also varied significantly across states ( Government Accountability Office, 2008). A 2003 report published by the Office of the Inspector General concluded that there was variability in how states went about determining citation practices as a result of inconsistent survey focuses, high staff turnover, unclear guidelines, and the lack of a common review process for draft survey reports ( Office of Inspector General, 2003). The health inspection domain has been criticized for using survey data that have poor reliability and high levels of variability. The NHC star rating system composed of three main components-state health surveys, quality data from the national minimum data set, and staffing information-has received criticism from providers, consumers, and researchers. They can serve as valuable tools to consumers when they offer accurate and useful data to compare indicators of quality across nursing homes ( Castle & Lowe, 2005 Mukamel & Spector, 2003 Stevenson, 2006). Quality report cards are often designed with the intention of helping consumers compare quality across nursing homes, especially among dimensions that may not be easily observable when visiting a facility ( Castle & Lowe, 2005 Mukamel & Spector, 2003 Mukamel et al., 2007 Stevenson, 2006). Although clinical data are undoubtedly important to examine in nursing homes, for many residents the facility is where they live for a long period of time, making the evaluation of quality of life measures important as well. The current quality measures reported on the NHC website all focus on resident’s physical and clinical services with none examining resident quality of life ( CMS, 2010). Quality indicators for nursing homes have often been subject to the criticism that they are too heavily focused on clinical aspects and lack focus on quality of life measures ( Castle & Ferguson, 2010). Simply put, do facilities with high star ratings also report high levels of resident and family satisfaction? Quality Indicators and Report Cards Little research has been done to study how the CMS star ratings compare to the satisfaction scores of residents and family members. Although these measures include important elements of nursing home quality, two crucial pieces of information missing are data on family and resident satisfaction. Today, the site publicly rates nursing homes on a five-star scale based on data related to staffing, performance on quality indicators taken from Minimum Data Set (MDS) information, and information gathered through health inspections ( Centers for Medicare and Medicaid Services, 2010). In 2002, CMS launched a nationwide media campaign consisting of television and newspaper advertisements that promoted NHC as a major source of information on nursing home quality ( Grabowski & Town, 2011 Office of Inspector General, 2004). This report card, called Nursing Home Compare (NHC), originally reported only on basic nursing home characteristics but has since grown to include an array of quality information ( Grabowski & Town, 2011). In 1998, the Centers for Medicare and Medicaid Services (CMS) launched an online quality report card that was designed to provide consumers with information on every Medicare- and Medicaid-certified nursing home in the United States ( Castle, 2009 Castle & Ferguson, 2010). Long-term care, Nursing homes, Quality of care, Quality of life, CMS data sets (OSCAR, MDS)
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