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The 5-Star Nursing Home Rating System Is A Farce

It seemed like a good idea in December 2008 when the Centers for Medicare & Medicaid Services rolled out a 5-Star Quality Rating System to help consumers, families, and caregivers compare nursing homes more easily. By definition, a 5-star rating means that a facility ranks in the top 10% in each state. Because the agencies were already inspecting nursing homes and publishing their findings, adding more data was thought to be positive. And indeed it was. The CMS system became a reliable and simple system for comparing apples-to-apples.

With a few clicks, anyone can get information about any nursing home in the United States and see a single rating plus separate ratings for Health Inspections, Staffing, and Quality Measures (QMs) – which are 15 different physical and clinical measures that give a snapshot for how well nursing homes care for residents’ physical and clinical needs. The problem is that the ratings are a joke because the nursing homes themselves quickly figured out ways to “game” the system.

Take, for example, the reporting of major injuries, which is one of the most important factors in determining which facilities are better than others. When a nursing home resident falls and breaks a bone, it is often an indication of negligence and understaffing. Such accidents are not common in better-staffed and better-managed facilities.

Just this week the New York Times published results from an in-depth investigation that found:

·       Much of the information submitted to CMS is wrong.

·       Some nursing homes inflat their staffing levels by, for example, including employees who are on vacation.

·       The government rarely audits the nursing homes’ data.

·       Surprise inspections are not always a surprise. Some nursing homes are being tipped off.

The system is well-intended but has been broken for quite a while. Last year, researchers at the University of Chicago, Department of Public Health Sciences, published an extensive study looking at data from 2011-2015 and discovered the following:

“We identified 150,828 major injury falls in claims that occurred during nursing home residency. For the MDS item used by NHC, only 57.5 percent were reported. Reporting was higher for long‐stay (62.9 percent) than short‐stay (47.2 percent), and for white (59.0 percent) than nonwhite residents (46.4 percent).”

What this means is that when nursing home residents fall and suffer major injuries, those “accidents” are reported less than 63% of the time. If you were a “nonwhite” resident of a nursing home and suffered an accident, there was a better than 50% chance that the care home would not report the incident to CMS.

Why would nursing homes fail to report a major injury fall? Well, guess what? The more “accidents” and injuries they report, the lower their star rating. If they “forget” to report a major injury fall, their ratings stay the same or may even go up.

How can the Nursing Home Rating System be improved?

Wouldn’t it be great if the CMS system accurately reflected conditions, staffing, and quality inside nursing homes? It is a laudable objective, and one which we can all agree is a good idea. The problem is that the nursing homes themselves have figured out how to cover up signs of understaffing, neglect, and outright abuse. There aren’t enough inspectors available to keep track of everything facility all the time, so the government data are often based on nursing home self-reports. When millions of dollars are at stake, it’s fair to assume that the nursing home chains will find a way to rig the system to their advantage – and they do.

What are consumers supposed to make of the 5-star rating system? Caveat emptor – buyer beware! Don’t be fooled and take everything the nursing homes give you with a lot more than a grain of salt.

Attorney Wendy York of York Law Firm specializes in prosecuting nursing home abuse, elder abuse and wrongful death cases in California. If you are in need of legal assistance please contact Wendy York today.