Nursing Home Rating System Needs Improvements: GAO Report

A federal regulatory watchdog agency is calling for changes in how the government ranks nursing homes, indicating that the current ranking system needs to be more useful for families looking for a place to care for their loved ones. 

Last month, the Government Accountability Office (GAO) issued a report (PDF) that examines the Nursing Home Compare website and five-star rating system managed by the U.S. Centers for Medicare and Medicaid Services (CMS), at the behest of lawmakers who were concerned following media criticism of the system.

The CMS rating site collects data on about 15,600 nursing homes nationwide. It rates them on a five-star system based on health inspections, staffing and quality measures, but those ratings are only in comparison to other facilities in the same state.

The GAO report includes four major recommendations. It calls for CMS to make the website more user-friendly; to make the rating system comparable on a national level, instead of just a state level; to add customer satisfaction information; and better, and prominently, explain how the ratings are calculated, how each different component is weighted, and how they compare nationally.

The Department of Health and Human Services, which oversees CMS, agreed with all of the recommendations, except the one which called for the ratings to compare at the national level, instead of at the state level, saying that it was currently not feasible.

The GAO also found problems with how CMS updates its Nursing Home Compare website, including how to prioritize recommended changes and assessing the effectiveness of its improvements. The report indicated that CMS used a “fragmented” approach, which worked well early on, but has become more difficult as the website became more complex.

“CMS has stated the goal for its Nursing Home Compare website as assisting consumers in finding and comparing information about nursing home quality. In addition, under federal internal control standards, management should address identified program deficiencies on a timely basis and evaluate appropriate actions for improvement,” the GAO report states. “However, in the absence of an established process to evaluate and prioritize implementation of improvements, CMS cannot ensure that it is fully meeting its goal for the website.”

The report comes about a year after the GAO found that data collected by CMS made it unclear whether nursing homes are actually improving and getting safer, or whether there are problems with data collection which prevents all of the problems from being accurately reported.

CMS is responsible for the monitoring nursing homes as part of reimbursement for care provided to millions of Americans. The agency 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.

Many patients and families face uncertain nursing home standards when searching for a long-term care facility. Care may be lacking for a number of reasons, including nursing home neglect, abuse, malnutrition, and injuries from falls.