![]() ![]() 13, 14 It is possible that having greater resources could play a role in an NH’s response to a disaster, as staffing-related expenses for natural disasters are not routinely covered by states. 11, 12 This differential selection has led to larger financial resources flowing to high-quality NHs (eg, reimbursed through Medicare or privately paid), whereas low-quality NHs are reliant on the smaller margins of Medicaid reimbursement. 10 Although the 5-star system was developed to improve quality by increasing the public’s ability to choose a higher-quality provider, some have suggested it has widened disparities in resident health as consumers with greater resources differentially select higher-quality facilities. ![]() 8 Research suggests that 1-star rated facilities have heightened risks of resident mortality 9 and preventable hospitalizations. ![]() The overall rating represents facility performance in 3 categories that receive their own star ratings, health inspections, resident quality measures, and overall staffing comprising registered nurse staffing and total direct-care staffing. Higher star values suggest better quality on a set of objective components that include an overall quality rating from 1 to 5 stars. NHs are rated by the Centers for Medicare & Medicaid Services (CMS) through its Five-Star Quality Rating System, results of which are made available on CMS’s NH Compare website. 7 However, less is known about the relationship between facility quality and staffing-related response during a major hurricane event. 1– 6 NHs often increase staffing levels to adequately meet the needs of their residents during a natural disaster. Several studies have reported an increased rate of hospitalization and mortality for NH residents following a major hurricane event. Nursing homes (NHs) are uniquely affected by hurricanes and other natural or human-made disasters. ![]()
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