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Q&A: N.C. Adult Care Facilities Reach for the Stars

Two new rating systems are in place. Don't be confused about their details.

Two new rating systems are now available to help families search for an assisted living facility or nursing home in North Carolina. It’s easy to confuse the programs, which both use stars as a measurement. The AARP Bulletin will help you sort out the details between the two.

Q. What do the stars mean?

A. The federal government issued its first ratings for nursing homes in December. It uses five stars—one star is the lowest, five is the best. North Carolina began to implement its rating system for assisted living facilities in January. Its system also is based on a scale, from zero to four stars, from worst to best. The ratings provide a starting point for your research. “This is a piece of the puzzle but it’s not the whole thing. Before, consumers really didn’t have a place to begin,” said Bill Wilson, associate state director for advocacy at AARP North Carolina.

Q. How does the North Carolina program work?

A. The ratings are based on an annual inspection that evaluates personal care, safety measures, medication management and other issues. About 1,300 assisted living facilities, adult care homes and smaller family care homes will be rated throughout the year after they have been inspected. All facilities should have a rating by early next year. A facility must score 100 points two years in a row to receive a four-star ranking. That means none will receive the coveted four stars until at least next year.

Q. Why is it necessary?

A. AARP North Carolina and other aging advocates were instrumental in getting lawmakers in 2007 to authorize the system as a way to provide objective information to families. Last year, AARP worked with the state Medical Care Commission as it developed rules for the program. “This is an important consumer decision, much more than money and much, much more than how a place looks,” said Barbara Ryan, chief of the adult care licensure section of the North Carolina Division of Health Service Regulation. She said the ratings provide some value to families who often make important care decisions in a crisis mode.

Q. How does the federal system work?

A. The second system was created by the federal Centers for Medicare & Medicaid Services. It awards stars for the more than 15,000 nursing homes nationwide, including about 400 in North Carolina, that participate in Medicare and Medicaid. When the ratings were announced, 14 percent of North Carolina homes received the best five-star rating and 29 percent received just one star. For comparison: Nationwide, 12 percent received five stars and 23 percent received one. The CMS ratings are updated monthly.

Q. What if I am considering skilled nursing as well as assisted living?

A. If a facility has both, it would be rated by the federal system.

Q. What does the industry think about the ratings?

A. Many in the industry are less than enthusiastic. Ted Smith is the administrator at Hillcrest Convalescent Center in Durham, which received four stars under the federal nursing home rating system. He said the ratings are a great idea in theory, but he said the ratings could be based on stale or inaccurate information. “Even though we are a good facility and we received a good score, it’s not just kinks that need to be worked out. It’s based on a house of cards,” Smith said.

Q. This is a big decision. Can I rely on the ratings?

A. While the ratings can be helpful to consumers searching for living arrangements, AARP and others urge people to visit the facilities often. Talk to current residents and their families, not just the staff. The more homework you do, the more comfortable you will be with this important decision.

Natalie Gott has covered government and policy for seven years. She is based in Chapel Hill.

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