Now you can shop for a five-star nursing home

WASHINGTON -- The U.S. has five-star rankings for restaurants and hotels. So why not five-star rankings for nursing homes?

The Bush administration announced Wednesday that it will put in place such a rating system by the end of the year. It's designed to give consumers another tool to consider when shopping for a nursing home. The ratings would be placed on a government Web site.

"The fact a home has a lower rating will likely put them on the path to improvement," said Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services. "I don't think we're going to see many people who are very anxious to put a loved one in a one-star home."

The agency said it would seek comment from the industry and consumers to determine the criteria for the rankings.

In announcing their intentions, federal officials also unveiled new regulations that will require all nursing homes to have in place sprinkler systems by 2013. Homes that fail to have the sprinkler systems could not serve Medicare participants.

Newer nursing homes all have sprinkler systems, but many older homes do not. Overall, the government estimates that about one out of every 11 nursing homes don't have sprinkler systems. Still others only have partial sprinkler systems and will have to make improvements. Overall, there are about 16,000 nursing homes in the United States.

In 2004, the Government Accountability Office recommended that federal health officials explore requiring sprinklers in all nursing homes. The recommendation came one year after 31 residents died in nursing home fires in Hartford, Conn., and Nashville, Tenn.

Federal regulations did not require either home to have automatic sprinklers and both fires broke out at night when staffing was at its lowest level.

There has never been a multiple-death fire in a nursing home with a full sprinkler system, government auditors said.

The five-year window for putting in place a sprinkler system was designed to give nursing homes time to plan and finance the undertaking, but they shouldn't expect federal loans or grants to help pay for it. The estimated cost of the improvements over five years amounts to about $850 million.

"Nursing homes finance improvements to their physical plant all the time. This is the kind of improvement they need to keep residents safe, so we don't contemplate specific grants for nursing homes who are not in compliance with the rule," Weems said.

To comply with regulation, nursing homes must have sprinkler coverage in the residents' rooms, the kitchen, dining area, hallways and offices as well as several other sections.

Exactly what information that the Medicare agency will use to rate nursing homes is still being determined, but will include observations from federal and state inspections as well as staffing levels. Weems said the idea for the ranking system came during a hearing when Sen. Ron Wyden, D-Ore., asked him why it was easier to compare washing machines than nursing homes.

"Sitting there at that table, I remember thinking, 'he's right.,'" Weems said.

The nursing home industry said it supports the new requirement on sprinkler systems, but is worried about the expense. Nonprofit homes operate at very low margins, said Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, which represents about 2,500 nursing homes. He called on lawmakers to accelerate passage of legislation that would provide nursing homes with low-interest loans.

"For those homes that are not yet fully sprinklered there is the concern that without financial support through grants or low-interest loans, the funding may have to come out of some other part of care or services," Minnix said.

Another industry trade group, the American Health Care Association, said the new ranking system should not rely solely on data obtained through inspections. It should also incorporate consumer and staff satisfaction.

"We do not believe that an index which relies upon a broken survey system is an accurate way to measure quality," said Bruce Yarwood, the association's president and CEO.