Ludington, MI

Medilodge of Ludington

3-star overall rating with 3-star inspections with 7 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle

1000 East Tinkham Avenue, Ludington, MI

(231) 845-6291

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

3 / 5

Survey and complaint cycles

Staffing

4 / 5

RN + nurse staffing

Quality measures

3 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Medilodge

Operator or chain grouping

Approved since

1980-02-01

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

50 facilities

Chain averages 3 overall / 3 health / 4 staffing / 4 quality stars

Changed ownership

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

1.28

Registered nurse staffing · state 0.77 · national 0.68

LPN hours / resident day

0.22

Licensed practical nurse staffing · state 0.88 · national 0.87

Aide hours / resident day

2.24

Nurse aide staffing · state 2.38 · national 2.35

Total nurse hours

3.74

All reported nurse hours · state 4.03 · national 3.89

Licensed hours

1.49

RN + LPN hours · state 1.65 · national 1.54

Weekend hours

2.87

Weekend nurse staffing · state 3.52 · national 3.43

Weekend RN hours

0.77

Weekend registered nurse coverage · state 0.49 · national 0.47

Physical therapist

0.05

Reported PT staffing · state 0.07 · national 0.07

Adjusted RN hours

1.32

CMS adjusted RN staffing hours

Adjusted total hours

3.87

CMS adjusted total nurse staffing hours

Case-mix index

1.32

Higher values indicate more complex resident acuity

RN turnover

25%

Annual RN turnover · state 41% · national 45%

Total nurse turnover

47%

Annual nurse turnover · state 44% · national 46%

SNF VBP

Value-based purchasing

Program rank

10,999

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

18.38

Composite VBP score used to determine payment impact.

Payment multiplier

0.9820

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

1.73

Baseline 19.32% · Performance 20.63% · Measure score 1.73 · Achievement 1.73 · Improvement 0

Healthcare-associated infections

Baseline 6.30% · Performance 8.41% · Measure score 0 · Achievement 0 · Improvement 0

Total nurse turnover

3.04

Baseline 45.95% · Performance 51.25% · Measure score 3.04 · Achievement 3.04 · Improvement 0

Adjusted total nurse staffing

2.58

Baseline 4.21 hours · Performance 3.81 hours · Measure score 2.58 · Achievement 2.58 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	10.9%	10.72% 0.2 pts worse	No Different than the National Rate · Eligible stays 130 · Observed rate 12.31% · Lower 95% interval 8.09%
Discharge to community	60.25%	50.57% 9.7 pts better	No Different than the National Rate · Eligible stays 103 · Observed rate 55.34% · Lower 95% interval 49.84%
Medicare spending per beneficiary	0.75	1.02 0.3 pts better
Drug regimen review with follow-up	92.16%	95.27% 3.1 pts worse	Numerator 94 · Denominator 102
Falls with major injury	0.98%	0.77% 0.2 pts worse	Numerator 1 · Denominator 102
Discharge self-care score	55.36%	53.69% 1.7 pts better	Numerator 31 · Denominator 56
Discharge mobility score	62.5%	50.94% 11.6 pts better	Numerator 35 · Denominator 56
Pressure ulcers or injuries, new or worsened	6.86%	2.29% 4.6 pts worse	Numerator 7 · Denominator 102 · Adjusted rate 6.05%
Healthcare-associated infections requiring hospitalization	8.41%	7.12% 1.3 pts worse	No Different than the National Rate · Eligible stays 66 · Observed rate 12.12% · Lower 95% interval 5.11%
Staff COVID-19 vaccination coverage	1.69%	8.2% 6.5 pts worse	Numerator 2 · Denominator 118
Staff flu vaccination coverage	22.09%	42% 19.9 pts worse	Numerator 36 · Denominator 163
Discharge function score	75%	56.45% 18.5 pts better	Numerator 42 · Denominator 56
Transfer of health information to provider	100%	95.95% 4 pts better	Numerator 74 · Denominator 74
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 4 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	33.93%	25.2% 8.7 pts better	Numerator 19 · Denominator 56

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	2.6	1.7 0.9 pts worse	1.9 0.7 pts worse	Long Stay · 20240701-20250630 · Adjusted 2.6 · Observed 2.5 · Expected 1.8 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	3.0	1.5 1.5 pts worse	1.8 1.2 pts worse	Long Stay · 20240701-20250630 · Adjusted 3.0 · Observed 3.0 · Expected 1.7 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	92.2%	95.0% 2.8 pts worse	93.4% 1.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 90.1% · Q2 88.6% · Q3 92.8% · Q4 97.2% · 4Q avg 92.2%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	74.0%	95.0% 21 pts worse	95.5% 21.5 pts worse	Long Stay · 2024Q3-2025Q2 · 4Q avg 74.0%
Percentage of long-stay residents experiencing one or more falls with major injury	3.9%	3.1% 0.8 pts worse	3.3% 0.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 2.8% · Q2 4.3% · Q3 4.3% · Q4 4.2% · 4Q avg 3.9% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	7.7%	4.1% 3.6 pts worse	11.4% 3.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 10.0% · Q2 3.8% · Q3 3.8% · Q4 12.1% · 4Q avg 7.7%
Percentage of long-stay residents who lose too much weight	5.7%	5.5% 0.2 pts worse	5.4% 0.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 10.0% · Q2 8.6% · Q3 3.6% · Q4 0.0% · 4Q avg 5.7%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	17.3%	19.6% 2.3 pts better	19.6% 2.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 18.0% · Q2 19.7% · Q3 17.2% · Q4 14.0% · 4Q avg 17.3%
Percentage of long-stay residents who received an antipsychotic medication	17.3%	16.5% 0.8 pts worse	16.7% 0.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 11.9% · Q2 17.8% · Q3 19.6% · Q4 19.6% · 4Q avg 17.3% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.1% 0.1 pts better	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	21.2%	13.9% 7.3 pts worse	16.3% 4.9 pts worse	Long Stay · 2024Q4-2025Q3 · Q4 11.9% · 4Q avg 21.2% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	13.6%	11.7% 1.9 pts worse	14.9% 1.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 16.4% · Q2 19.7% · Q3 7.0% · Q4 10.7% · 4Q avg 13.6% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.0%	0.9% 0.9 pts better	1.0% 1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	2.9%	1.7% 1.2 pts worse	1.7% 1.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 2.9% · Q2 3.0% · Q3 3.0% · Q4 2.9% · 4Q avg 2.9% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	27.2%	20.4% 6.8 pts worse	19.8% 7.4 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 26.9% · Q2 36.1% · Q3 24.6% · Q4 21.0% · 4Q avg 27.2%
Percentage of long-stay residents with pressure ulcers	5.4%	5.6% 0.2 pts better	5.1% 0.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 1.5% · Q2 8.1% · Q3 6.4% · Q4 5.9% · 4Q avg 5.4% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	76.6%	82.8% 6.2 pts worse	81.7% 5.1 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 64.5% · Q2 78.5% · Q3 81.5% · Q4 80.8% · 4Q avg 76.6%
Percentage of short-stay residents who had an outpatient emergency department visit	14.8%	11.5% 3.3 pts worse	12.0% 2.8 pts worse	Short Stay · 20240701-20250630 · Adjusted 14.8% · Observed 15.8% · Expected 11.9% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	2.4%	1.3% 1.1 pts worse	1.6% 0.8 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 1.7% · Q2 5.2% · Q3 3.1% · Q4 0.0% · 4Q avg 2.4% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	68.2%	79.5% 11.3 pts worse	79.7% 11.5 pts worse	Short Stay · 2024Q3-2025Q2 · 4Q avg 68.2%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	34.1%	24.2% 9.9 pts worse	23.9% 10.2 pts worse	Short Stay · 20240701-20250630 · Adjusted 34.1% · Observed 35.8% · Expected 25.0% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-02-13 · Fire 2025-02-13

7 health deficiencies

Top issue: Resident Rights (3 deficiencies)

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 2 Health 2024-01-24 · Fire 2024-01-24

13 health deficiencies

Top issue: Resident Rights (3 deficiencies)

2 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)

Cycle 3 Health 2022-12-13 · Fire 2022-12-13

14 health deficiencies

Top issue: Quality of Life and Care (7 deficiencies)

2 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-02-13

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2025-08-11

E · Potential for more than minimal harm 2025-02-13

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2025-03-21

E · Potential for more than minimal harm 2025-02-13

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-03-21

F · Potential for more than minimal harm 2024-01-24

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2024-02-26

E · Potential for more than minimal harm 2024-01-24

K321 · Smoke Deficiencies

Fire Safety

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Corrected 2024-02-26

F · Potential for more than minimal harm 2022-12-13

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-01-10

E · Potential for more than minimal harm 2022-12-13

K363 · Smoke Deficiencies

Fire Safety

Install corridor and hallway doors that block smoke.

Corrected 2023-01-10

Inspection history

Recent health citations

G · Actual harm 2025-08-29

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2025-09-25

D · Potential for more than minimal harm 2025-07-09

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Corrected 2025-06-02

G · Actual harm 2025-04-18

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2025-05-15

E · Potential for more than minimal harm 2025-04-18

F726 · Nursing and Physician Services Deficiencies

Health

Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Corrected 2025-05-15

D · Potential for more than minimal harm 2025-02-13

F550 · Resident Rights Deficiencies

Health

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Corrected 2025-03-21

D · Potential for more than minimal harm 2025-02-13

F622 · Resident Rights Deficiencies

Health

Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.

Corrected 2025-03-21

D · Potential for more than minimal harm 2025-02-13

F625 · Resident Rights Deficiencies

Health

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Corrected 2025-03-21

E · Potential for more than minimal harm 2024-10-24

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2024-12-02

E · Potential for more than minimal harm 2024-10-24

F761 · Pharmacy Service Deficiencies

Health

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Corrected 2024-12-02

E · Potential for more than minimal harm 2024-10-24

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-12-02

E · Potential for more than minimal harm 2024-09-25

F658 · Resident Assessment and Care Planning Deficiencies

Health

Ensure services provided by the nursing facility meet professional standards of quality.

Corrected 2024-10-24

D · Potential for more than minimal harm 2024-09-25

F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Corrected 2024-10-24

D · Potential for more than minimal harm 2024-09-25

F676 · Quality of Life and Care Deficiencies

Health

Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

Corrected 2024-10-24

D · Potential for more than minimal harm 2024-09-25

F690 · Quality of Life and Care Deficiencies

Health

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Corrected 2024-10-24

E · Potential for more than minimal harm 2024-07-09

F842 · Resident Assessment and Care Planning Deficiencies

Health

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Corrected 2024-08-06

D · Potential for more than minimal harm 2024-07-09

F761 · Pharmacy Service Deficiencies

Health

Corrected 2024-08-06

E · Potential for more than minimal harm 2024-01-24

F550 · Resident Rights Deficiencies

Health

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Corrected 2024-02-26

E · Potential for more than minimal harm 2024-01-24

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-02-26

D · Potential for more than minimal harm 2024-01-24

F578 · Resident Rights Deficiencies

Health

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Corrected 2024-02-26

D · Potential for more than minimal harm 2024-01-24

F847 · Administration Deficiencies

Health

Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.

Corrected 2024-02-26

D · Potential for more than minimal harm 2023-10-19

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2023-11-15

E · Potential for more than minimal harm 2023-04-27

F584 · Resident Rights Deficiencies

Health

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Corrected 2023-06-01

E · Potential for more than minimal harm 2023-04-27