How to Improve Your Nursing Home’s 5-Star Rating: Key Quality Measures That Matter

Understanding the 5-Star Rating System

Does your 5-star rating keep you up at night? You’re not alone. Many nursing home administrators find the CMS (Centers for Medicare & Medicaid Services) star rating system confusing, especially when trying to determine how to improve it. While numbers aren’t everything, this rating system is a benchmark to let the public know how a facility performs in three critical areas compared to regional competitors: health inspections, staffing, and quality measures.

Whether you're attracting new staff, contracting with a Medical Director, or building community trust, your rating matters. As someone who regularly consults with facilities and is asked to consider leadership roles, I always look at a facility’s 5-star rating before making decisions.

Where to Start: Focus on Quality Measures

The best place to start when trying to boost your 5-star rating is your quality measures. This category reflects the outcomes and care standards within your facility, and small, strategic changes can lead to significant improvements. Improving your quality of care for residents while simultaneously improving your quality measures can result in better care for residents, which everyone should focus on.

Why Hospitalization Rates Matter

One of the key components of quality measures is your hospitalization rate. Facilities with high rates of hospital transfers may be signaling that they:

• Struggle to manage chronic conditions effectively
• Fail to prevent avoidable infections
• Lack a strong fall prevention program

Lowering unnecessary hospital visits doesn't just help your rating; it’s a clear sign your team is delivering competent, proactive care.

Antipsychotic Prescribing: Small Change, Big Impact

Antipsychotic medication use is another important factor. Unless prescribed for schizophrenia, Huntington’s disease, or Tourette’s Syndrome, these medications can negatively impact your quality score. Work closely with your Medical Director and consultant pharmacist to:

• Review and justify current antipsychotic use
• Explore non-pharmacologic interventions
• Educate staff on behavior management

Even a modest reduction in usage can significantly boost your facility’s quality score.

Pressure Ulcers: A Red Flag for Substandard Care

New or worsening pressure ulcers are not only painful and dangerous for residents, but they’re also another care category in the quality measures. These ulcers often reflect poor staffing levels, inadequate repositioning schedules, or ineffective wound care practices.

To reduce this risk:

• Implement a strong wound care program
• Ensure consistent support from dietary services for healing
• Maintain adequate staffing for regular skin assessments and repositioning

Other Key Metrics to Monitor

Beyond hospitalizations, antipsychotic use, and pressure ulcers, the CMS quality measures also include:

• Vaccination rates (staff and residents)
• Urinary catheter usage
• Unplanned weight loss
• Other factors

Review each of these indicators individually to identify specific improvement opportunities.

Change Is Possible With the Right Mindset

Improving your 5-star rating is absolutely possible, but it requires honest self-assessment, team collaboration, and a commitment to continuous improvement. The good news? Even simple, focused steps can create meaningful change, not just in your numbers, but in the daily experiences and health outcomes of your residents.

Because at the end of the day, quality care should be the true goal. The rating? That’s just the reflection of how well you're delivering it.