U.S. Nursing Home Rating System Broken, Misleading: New York Times Report

An investigative report by the New York Times indicates the current “five star” rating system for U.S. nursing homes is not just broken, but often misleading for families and residents, who expect it to be an accurate measure of the quality of care provided at facilities nationwide.

The Times conducted a comprehensive analysis of data used to create the five-star nursing home rating system compiled by the Centers for Medicare and Medicaid Services (CMS), finding that the system is extremely lacking, particularly for users who are often making a heartbreaking and sometimes desperate decisions to place a family member into a long-term care facility.

The report notes that the ongoing COVID-19 pandemic, which has disproportionately affected nursing home residents, has only highlighted a long-standing problem.

Nursing Home Rating Problems

The CMS nursing home ratings collect data on about 15,600 long-term care facilities nationwide, providing a five-star ranking based on health inspections, staffing and quality measures. However, those ratings are only in comparison to other facilities in the same state.

The New York Times report indicates the system has basically become a way for facilities to market themselves, while hiding deep and systemic problems with nursing home neglect and abuse, medication errors and violence against the elderly.

Part of the problem is that, in addition to occasional on-site inspections, the ratings rely heavily on self-reported data from the nursing homes themselves.

While the issue has only come to the forefront with the deaths of more than 130,000 nursing home residents over the last year due to the pandemic, there have long been warning signs about problems with nursing home ratings.

In December 2016, for example, the Government Accountability Office issued a report which called for significant changes to the rating system, including a better explanation for how the ratings are calculated, how each different component is weighed, and how the facilities compare to one another nationally.

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.

The New York Times indicates its reporters went through the raw CMS data to come to their own conclusions, and found that much of the data submitted to CMS is wrong, and those errors seem to always make the nursing homes look better than they really are in practice. They also found inflated staffing levels, that some nursing homes likely know in advance that “surprise” inspections are coming, and that five-star facilities are almost just as likely to fail actual inspections as they are to pass them.

The report found that, when faced with the terrors of the pandemic, many nursing homes appeared more focused on increasing their five-star rating than they did increasing actual safety for residents.

Federal investigators are exploring the possibility of nursing home neglect playing a role in the COVID-19 outbreak, which was first detected in a nursing home in Washington State that became the epicenter for the U.S. pandemic. Investigators say the nursing home failed to respond to the outbreak adequately, placing residents in jeopardy of illness and death.