Nursing Home Quality Improvement Initiative

What is the Nursing Home Quality Improvement Initiative?

The Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services have collected information about residents in nursing homes for the public. CMS has developed an enhanced set of quality measures to provide to consumers (online at CMS has broken down the quality measures into two categories: one for long term residents and the other for short stay (post-hospital care) residents. All of the quality measures are negative measures and measure undesirable conditions and outcomes. The following are a list of quality measures:

Long-term (chronic care) Residents

  • Percent of residents whose need for help with daily activities has increased
  • Percent of residents who have moderate to severe pain
  • Percent of residents who were physically restrained
  • Percent of high-risk residents who have pressure sores
  • Percent of low-risk residents who have pressure sores
  • Percent of residents with a urinary tract infection
  • Percent of residents who spent most of their time in bed or in a chair
  • Percent of residents who have become more depressed or anxious
  • Percent of low-risk residents who lose control of their bowels or bladder
  • Percent of residents who have/had a catheter inserted and left in their bladder
  • Percent of residents whose ability to move about in and around their room decreased
  • Percent of chronic/long term care residents who lose too much weight

Short-stay (temporary) Residents

  • Percent of short stay residents who had moderate to severe pain
  • Percent of short stay residents with delirium
  • Percent of short stay residents with pressure sores

From where do the data for the quality measures come?

When a person is admitted to a nursing home, the nursing home staff do an assessment of the resident's condition. That information is then sent to CMS, which then provides it to the State Department of Health, which is responsible for evaluating nursing homes each year. State surveyors use this information during their survey process to assess for deficiencies.

Information about each resident is included in the nursing home's total results. In the information published for consumers, each nursing home is then compared to other facilities in that state. A nursing home's rating (percentile rank) represents the percentage of facilities in that state whose results are lower or smaller for that condition.

How should I use this information?

CMS has developed this initiative to give consumers more information about the quality of care in nursing homes (online at Some of the information in the quality measures is skewed, so as you are evaluating a nursing home, keep this in mind. For example, a nursing home that specializes in wound care may accept many residents with bedsores and appear to have a high number of pressure ulcers while giving good quality care. Another nursing home that does not accept these types of residents, but gives substandard care that causes pressure sores may not rate as high. If there are concerns about the measures, ask questions of the nursing home.

If I have concerns about quality of care in the nursing home, to whom should I talk?

The nursing home medical director, a loved one’s attending physician, administrator, social services director, and director of nursing are the best information resources. Document concerns and take notes during any meetings with these individuals.


Overview of Nursing Home Quality Initiative

Nursing Home Compare