The Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Rating System to help nursing home consumers and their families more easily compare nursing homes and identify areas that they might like to ask questions about. Yet, because the rating system relies on self-reported data, the accuracy of nursing home ratings is unreliable.
To protect your loved ones and do all that you can to place them in a safe, secure facility, nursing home consumers and their families should not rely solely on the 5-star rating system. Instead, you should conduct your own independent assessment before placing a loved one in any nursing home.
The Nursing Home Compare 5-Star Rating System Is Unreliable
The Nursing Home Compare 5-star nursing home ratings system was created in 2008 to help nursing home consumers and their families sift through vast amounts of data on nursing home performance. The goal was to make it easier for consumers to identify nursing homes that will care for their loved ones and keep them safe.
The Nursing Home Compare website assigns each nursing home a score of 1 to 5 stars, with 1 being the lowest rating and 5 being the highest. A nursing home receives an “Overall rating” as well as separate ratings for health inspections, staffing, and quality measures.
According to the CMS website,
- Health Inspections ratings address the 3 most recent health inspections plus any inspections that were conducted in response to complaints. “Information is gathered by trained, objective inspectors” who visit the nursing home and “follow a specific process to determine the extent to which a nursing home has met Medicaid and Medicare’s minimum quality requirements.”
- Staffing ratings refer to the “number of hours of care provided on average to each resident each day by nursing staff.” The rating “considers differences in the levels of residents’ care needs in each nursing home” with the expectation that “a nursing home with residents who have more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.”
- Quality Measures (QMs) have “information on 15 different physical and clinical measures for nursing home residents” and “offer information about how well nursing homes are caring for their residents’ physical and clinical needs.”
The system was intended to distill large amounts of information into an easily accessible tool that would help consumers and their families make a decision about which nursing home would be best for their loved ones.
However, nursing homes have manipulated the 5-star system to cover up problems at individual facilities. As a result, consumers should question the accuracy and reliability of the nursing home star rating system.
Nursing Home Ratings Are Manipulated
The nursing home 5-star rating system relies on self-reported data from nursing home facilities. That data is combined with reports from on-site examinations conducted by health inspectors. However, much of the information submitted by nursing homes is simply wrong and makes a nursing home seem cleaner and safer than it really is.
Shockingly, even though many nursing homes know about so-called “surprise” inspections, state health inspectors still found problems with abuse and neglect.
In fact, nursing homes that receive 5-star ratings are almost just as likely to fail in-person inspections as they are to pass them. Shockingly, even though many nursing homes know about so-called “surprise” inspections, state health inspectors still found problems with abuse and neglect. Yet, in many cases, these problems were not deemed severe enough to result in a lower rating.
Common ways nursing homes manipulate data to improve ratings include inflating staffing levels to show a better resident-to-staff ratio, underreporting the number of residents who are receiving antipsychotic medications or other chemical restraints, and underreporting the number of accidents that occur at a facility.
Inflating Staffing Levels
Insufficient staffing is a common cause of nursing home injuries. For example, a resident who needs help going to the bathroom may try to go on their own if no one comes to help. The resident could lose their balance, fall, and suffer a serious injury such as a broken bone or head trauma.
To address this concern, nursing homes are evaluated on the number of nursing hours they provide per resident per day, and CMS includes staffing ratings on Nursing Home Compare.
However, there is no federal law that sets a minimum resident-to-staff ratio, and Ohio state law simply requires that each nursing home have enough staff to meet the needs of the residents and to provide each resident with at least 2.5 hours of direct nursing care per day.
As a result, nursing homes have an incentive to over-report the number of people on staff at a given time to make it appear that residents are receiving more care than they actually are. Nursing homes may do this, for example, by including staff members who are on vacation in their reports to CMS.
Underreporting Patients on Antipsychotics and Other Medications
In addition to over-reporting staffing levels, nursing homes often underreport the number of residents who are being given antipsychotic drugs, chemical restraints, or other medications. The use of these medications is a serious and long-standing problem in nursing homes.
Drugs are frequently given to nursing home residents to control the symptoms of dementia. They often have a sedative effect, which makes it easier for nursing homes to manage the people in their care. However, antipsychotic drugs, chemical restraints, or other medications often have adverse side effects and increase the risk of death in people with dementia. In nursing homes, they are often given without patient consent.
Nursing homes have also been found to underreport the number of patients who suffer from bedsores (also known as pressure ulcers), falls, and potential abuse or neglect. For example, a 2020 study found that the number of self-reported pressure ulcers was substantially lower than suggested by the number of patients at a given facility who were hospitalized. Similarly, a 2019 report found that nursing homes failed to report almost 40% of resident falls that required hospitalization. And reports by the Department of Health and Human Services Office of Inspector General show that many nursing homes fail to report potential abuse or neglect.
Yet despite the failings, many of these nursing homes continue to receive 5-star ratings.
Robenalt Law Seeks Justice for Victims of Nursing Home Abuse and Neglect
If you suspect a loved one has been a victim of nursing home abuse or neglect, the nursing home abuse lawyers at Robenalt Law can help. We investigate and handle nursing home abuse cases on a contingency fee, which means we don’t get paid unless we recover money for you.
Learn more about nursing home abuse and how a lawyer can help, get answers to Frequently Asked Questions, and contact us today to schedule a free, confidential consultation to discuss your case.
Tom Robenalt started his litigation career representing nursing homes at a large firm in Cleveland. For the past 25 years, he has used that experience to help victims and the families of those injured by negligent health care providers.