Nursing Homes are Gaming the Rating Systems

Ideas and Issues
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nursing home, health inspection, elderly healthcare, healthcare regulation

March 15, 2021

New Orleans      A dozen years ago, the US government created a consumer-facing rating system for nursing homes to allow families to make informed decisions about where to place loved ones in order to receive the best care they could afford. Homes would be rated by the number of stars they received after inspections and reporting in a number of categories including staffing and time with patients. The fact that 130,000 nursing home residents have died due to Covid-19 has forced a reckoning over what the quality of care really is in these homes, regardless of the ratings. In a shocking analysis by the New York Times, it appears that home operators have gamed the system in order to improve their ratings without having to improve the quality of their care.

All of this comes too close to home for Local 100 United Labor Unions because we represent a number of nursing homes in central and north Louisiana where our workers have been battling the pandemic to protect consumers, often with inadequate staffing and personal protection equipment. We have felt lucky that for the most part our homes have not been in the top ranks for deaths in the state, but we have also felt we were continuing to run hard to simply catch up.

The Times findings were pretty horrible by any standards. It’s hard not to see the rating system as worthless. Reviewing 373,000 reports by states and financial statements from 10,000 homes they found much of the information “submitted to CMS is wrong.” They found that staffing levels were routinely inflated. Homes often were alerted of inspections in advance. Worse, there was no correlation between homes supposedly at the top of the heap with five stars and whether or not they failed actual physical inspections. Where an observer would expect that a five-star rating would have meant fewer Covid deaths, that was also not necessarily the case.

Self-reporting has to be one of the factors for this gap between claims and quality. In a competitive market with little oversight, it was just easier to lie. The fact that 70% of nursing homes are now owed by for-profit companies that are often REITs making a real estate rather than a healthcare investment is also likely another part of the problem.

There were calls for more audits of the homes’ self-certifications of their quality, but that didn’t happen, despite the warnings coming from Medicare’s own advisory panel. It gets worse:

The Times found that from 2017 to 2019 health inspectors wrote up about 5,700 nursing homes, more than one out of every three in the country, for misreporting data about residents’ well-being. That included nearly 800 homes with top ratings. Some facilities didn’t tell the government about certain medications they were giving residents. Others didn’t disclose when residents took serious falls or developed bed sores. Even when inspectors discovered such misreporting, they didn’t conduct more detailed audits of all of the data that the homes submitted to C.M.S.

It makes you want to weep, but it’s not a time for mourning. It’s a time for rage and a demand that people do their jobs, miscreants be punished, and this systemic scandal be fixed. Stat!