A five-star rating system designed more than a decade ago to assess the quality of care at U.S. nursing homes is badly broken.
That’s the conclusion of an in-depth New York Times investigation, which concludes many of these facilities manipulate the data to improve ratings and hide inadequacies.
How does the rating system work?
The U.S. Centers for Medicare & Medicaid Services (CMS) designed its five-star system in 2009 to gauge how well nursing homes care for their patients. The system depends upon:
- Self-reported data from over 15,000 senior care centers
- In-person inspections by state investigators
- How much time nurses spend with residents and the quality of that care
Each of those areas is given a grade which gives nursing homes their star rating from one star for the worst facility to five stars for the best.
The newspaper’s investigation finds many flaws
The Times set out to evaluate the reliability of those ratings by reviewing more than 370,000 state inspections, combing through financial statements of more than 10,000 nursing homes and acquiring private data from academic researchers sanctioned by the CMS. Among the paper’s findings:
- Some nursing homes misreport staffing levels, inflating the numbers by including workers who are on vacation
- Facilities routinely submit false or mistake-ridden material, making themselves appear cleaner and safer
- Resident accidents and health issues are often not reported
- Many nursing facilities receive advance notifications about “surprise” inspections
- Many five-star facilities are just as likely to flunk inspections as to receive a passing grade
- The government rarely audits self-reported data from the facilities
The newspaper also found that more than 2,400 of the 3,500 five-star facilities were cited for patient abuse and failing to control infections.
COVID-19 exposed many nursing home flaws
Nursing home residents have been some of the most vulnerable during the coronavirus pandemic, with over 130,000 deaths reported. The Times’s analysis found instead of increasing the quality of care when the pandemic struck, many facilities focused on improving their ratings by hiding liabilities through false or incomplete reporting.