How facilities fared during COVID surge, 2020-21

infection rate

This is a measure of each facility’s infection rate, which is the reported COVID-19 cases divided by resident count. Nearly equal-sized groups of facilities received As, Bs, Cs, Ds or Fs based on how far their infection rates were from zero.

TO

No reported infections and up to 1.78 infections per 1,000 residents (3,024 facilities)

B.

1.78 to 7.58 infections per 1,000 residents (3,023)

C

7.58 to 18.66 infections per 1,000 residents (3,023)

D

18.66 to 34.25 infections per 1,000 residents (3,022)

F

More than 34.25 infections per 1,000 residents (3,022)

infection score

This score compares a facility’s COVID-19 infection rate to that of the surrounding county. Nearly equal-sized groups of facilities received As, Bs, Cs, Ds or Fs based on their ranking of infection scores, from low numbers of infections relative to the county to high.

TO

COVID-19 infections reported were 0% to 49% of county rate (3,016 facilities)

B.

COVID-19 infections were 49% to 211% of county rate (3,015)

C

COVID-19 infections were 211% to 496% of county rate (3,015)

D

COVID-19 infections were 496% to 888% of county rate (3,015)

F

COVID-19 infections were 888% or more of county rate (3,015)

death rate

This rating measures the nursing home’s unadjusted COVID-19 death rate, which is reported deaths divided by resident count. An A rating means a facility reported no COVID-19 deaths, while equal-sized groups of facilities received Bs, Cs, Ds or Fs based on how far their death rates were from zero. Facilities submitting inadequate data were marked “NA.”

TO

No deaths reported in the winter surge (5,138 facilities)

B.

Up to 1.53 deaths per 1,000 residents (2,494)

C

1.53 to 3.61 deaths per 1,000 residents (2,494)

D

3.61 to 7.45 deaths per 1,000 residents (2,494)

F

More than 7.45 deaths per 1,000 residents (2,494)

mortality score

This measures whether more residents died than would be expected after statistically controlling for the number of people infected with COVID-19 and risk factors such as average resident age. About one in three nursing homes reported no COVID-19 deaths in the winter surge and received an A rating. Bs reported some deaths but fewer than expected, Cs close to the expected number, and D and F more than expected. Facilities submitting inadequate data were marked “NA.”

TO

Zero COVID-19 deaths reported, including facilities with zero COVID-19 infections (5,281 facilities)

B.

Reported COVID-19 deaths were 75% of expected COVID-19 deaths or fewer (3,951)

C

Reported COVID-19 deaths were 75.1% to 125% of expected COVID-19 deaths (1,633)

D

Reported COVID-19 deaths were 125.1% to 200% of expected COVID-19 deaths (1,127)

F

Reported COVID-19 deaths were more than 200% of expected COVID-19 deaths (1,216)

Total daily nursing hours

The 2001 study recommended at least 4.1 hours of daily bedside care per resident, and more than that for highly impaired residents. This care includes time with registered nurses, licensed nurse practitioners and certified nursing aides. All facilities meeting this recommended minimum were divided into roughly equal sized groups, assigning A and B ratings based on staffing. We divided all facilities with staffing below the recommendation into roughly equal sized groups of Cs, Ds and Fs.

TO

More than 4.63 hours per resident each day (1,799 facilities)

B.

4.10 to 4.63 hours per resident each day (1,798)

C

3.56 to 4.10 hours per resident each day (3,795)

D

3.13 to 3.56 hours per resident each day (3,794)

F

Less than 3.13 hours per resident each day (3,794)

Daily RN hours

The 2001 study recommended at least 0.75 hours of daily bedside care per resident from a registered nurse, and more than that for highly impaired residents. Facilities meeting this recommended minimum were divided into equal sized groups, with A and B ratings assigned based on staffing. Facilities with staffing below the recommendation were divided into roughly equal sized groups of Cs, Ds and Fs.

TO

More than 0.97 hours per resident each day (1,278 facilities)

B.

0.75 to 0.97 hours per resident each day (1,278)

C

0.45 to 0.75 hours per resident each day (4,142)

D

0.28 to 0.45 hours per resident each day (4,141)

F

Less than 0.28 hours per resident each day (4,141)

Daily LPN hours

The 2001 study recommended that at least 0.55 hours of daily bedside care per resident should come from licensed practical nurses, and more than that for highly impaired residents. They deliver medical care and tests as ordered by registered nurses. Facilities meeting this recommended minimum were divided into roughly equal sized groups, with A and B ratings assigned based on staffing. Facilities with staffing below the recommendation were divided into roughly equal sized groups of Cs, Ds and Fs.

TO

More than 0.89 hours per resident each day (6,170 facilities)

B.

0.55 to 0.89 hours per resident each day (6,169)

C

0.47 to 0.55 hours per resident each day (881)

D

0.35 to 0.47 hours per resident each day (880)

F

Less than 0.35 hours per resident each day (880)

Daily CNA Hours

The 2001 study recommended at least 2.8 hours of daily bedside care per resident should come from certified nursing assistants or nursing assistant trainees. They perform critical tasks such as help with eating, using the toilet and adjusting bed positions. Facilities meeting this recommended minimum were divided into roughly equal sized groups, with A and B ratings assigned based on staffing. Facilities with staffing below the recommendation were divided into nearly equal sized groups of Cs, Ds and Fs.

CMS Overall Star Rating for 2020

The Five-Star Quality Rating System, shown on Medicare’s Nursing Home Compare website, factors in health inspections, staffing and other measures. Five-star facilities “have much above average quality,” the website says.