Nursing Home Falls and Bedsores Often Underreported in Rating Information: Study

Lower reporting of nursing home bedsores and falls lead to inaccurate safety ratings by the government, researchers warn.

New research suggests nursing home falls and nursing home bedsores are often underreported to federal regulators, resulting in inaccurate safety rating information being provided to families throughout the U.S.

In findings published this week in the Journal of the American Medical Association (JAMA), researchers note that between 2011 and 2017, the vast majority of nursing homes in the U.S. failed to report all incidents where residents were hospitalized due to falls or bedsores to the Centers for Medicare and Medicaid Services (CMS), which is the agency that oversees most U.S. nursing homes and maintains nursing home ratings.

Additionally, the researchers noted that underreporting of nursing home falls and bedsores typically varied greatly based on the racial and ethnic patient demographic within the facilities.

The study comes after flaws in the federal nursing home care rating system were outlined in a February 2023 report, indicating that data used to rate facilities nationwide is widely inaccurate and that many facilities fail to disclose certain issues to obtain better safety rankings. The report also criticized CMS and it’s Nursing Home Compare (NHC) website for allowing facilities to self-report much of the data used generate the ratings.

Nursing Home Rating Fall and Bedsore Problems

In this new study, researchers from the University of Chicago examined hospital admission claim records from 13,179 nursing homes nationwide and determined 131,000 long-term residents were hospitalized for either bedsores or falls between 2011 and 2017. Then they compared those records to minimum data set (MDS) reports from nursing homes to CMS, which are used to assess rankings on the NHC website.

After analyzing the data, the researchers found that 40% of hospitalizations from long-term nursing home resident fall injuries were not included in MDS reports from nursing home facilities. For long term resident hospitalizations due to bedsore, 33.3% were not included in MDS reports.

Overall, about 70% of nursing homes failed to give a full and accurate report of hospitalizations from falls or bedsores during the study’s time period, researchers determined.

The data also indicated that reporting rates for falls requiring hospitalizations were over 13% higher in nursing home facilities with majority white residents, while pressure sore reporting rates were over 5% higher in facilities with a majority non-white patient demographic.

Researchers stressed that CMS should rely more heavily on objective date for its federal nursing home care rating system, as opposed to MDS reports that allow nursing home facilities to underreport serious injuries like falls and bedsores.

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Nursing Home Fall Injury and Bedsore Lawsuits

Nursing home negligence lawsuits often allege serious injuries from bedsores and falls could have been prevented with proper care.

Bedsores pose a serious health risk for patients, as they can develop into open wounds which can become infected. The injuries most commonly develop in places with prominent bones beneath thin layers of skin, such as the heels, elbows and tailbone. Residents with limited mobility, who have trouble or are unable to move independently, face the greatest risk of the painful and potentially life-threatening pressure ulcers.

Studies have shown that underreporting of nursing home bedsore problems can heavily skew nursing home safety data, resulting in increased risk to residents.

Additionally, nursing home falls can cause hip and back fractures that can be life threatening for vulnerable older residents. Research has shown that nursing home falls could be reduced by fewer antipsychotics and better staffing.


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