Nursing Home Care Data Unclear On Whether Services Are getting Better Or Worse: GAO Report

Recent data on the quality of nursing home care raise serious questions about whether long-term care facilities are actually improving care and getting safer, or whether recent statistics may be a sign of problems with data collection. 

The U.S. Government Accountability Office (GAO) released a report (PDF) on November 30, at the request of the U.S. Centers for Medicare and Medicaid Services (CMS), which indicates that there are contradictory findings regarding nursing home care quality.

CMS is responsible for the monitoring nursing homes as part of reimbursement for care provided to millions of Americans. The agnecy is also responsible for tracking facilities that have a high probability of nursing home abuse and neglect, and taking appropriate actions against those facilities, such as denying medicare reimbursements.

The GAO report indicates that, on the one hand, some data indicates care deficiencies, staffing levels, and clinical quality measures have all improved over the last decade. However, there has been a significant increase in consumer complaints regarding nursing home care during that same time period, raising questions about whether the data is an accurate reflection.

The GAO notes that, for example, reports of serious deficiencies have decreased by 41%, while consumer complaints increased by 21% over the same time period, from 2005 through 2014.

“The Centers for Medicare & Medicaid Services’ (CMS) ability to use available data to assess nursing home quality is complicated by various issues with these data, which make it difficult to determine whether observed trends reflect actual changes in quality, data issues, or both,” the GAO noted. “In recent years, CMS has made numerous modifications to its nursing home oversight activities, but has not monitored the potential effect of these modifications on nursing home quality oversight. Some of the modifications have expanded or added new oversight activities, while others have reduced existing oversight activities.”

In essence, the GAO found that CMS itself simply does not know whether its oversight of nursing home care quality is effective due to the number of recent changes it has made. In addition, CMS does not have a good way of monitoring the effectiveness of oversight changes made by state agencies either.

The GAO makes three recommendations to the CMS in its report. First, it calls for the administrator to establish specific timeframes for “development and implementation of a standardized survey methodology across all states,” including setting milestones to track progress. Second, the GAO calls for a plan to audit data self-reported by nursing homes, such as staffing data and clinical quality measures. Third, the GAO calls for a process of monitoring modifications of essential oversight activities made by the CMS to ensure they do not adversely affect CMS’s ability to assess nursing home quality.

“CMS is in the process of taking steps to address some of these problems,” the GAO concluded. “If properly implemented, completion of these steps…has the potential to make nursing home quality data more comparable and accurate, allowing more effective tracking of nursing home quality trends.”