Researchers Call for Updates to Federal Nursing Home Care Rating System

Resident’s complaints should play a much more important role in the Nursing Home Care rating system, researchers determined

A new study suggests that the current nursing home rating systems used by governing agencies may not accurately reflect the quality of care provided, placing residents at risk by withholding fair and accurate information from families making care decisions.

The current “five star” rating system used to rank nursing home in the United States contains flaws, which allow resident complaints to be under shadowed by other survey scores, according to a new report published in the medical journal JAMA Network Open on February 7.

The Centers for Medicare and Medicaid Services (CMS) nursing home rating system collects data on long-term care facilities nationwide, providing a five-star ranking based on health inspections, staffing, complaints and recertification surveys. However, those ratings are combined into a single health inspection rating.

In this latest study, researchers looked at recertification surveys and complaint investigation data from 15,499 nursing homes nationwide, to determine whether the CMS five-star rating genuinely reflects the quality of care one would expect when registering to become a resident.

To do this, researchers constructed two independent ratings for the nursing homes. One rating based on recertification survey results, and the other based on complaint investigations.

Researchers found that among the 15,499 nursing homes, 19.8% had one overall health inspection star, 23.2% had two stars, 23.2% had three stars, 23.2% had four stars, and 9.8% had five overall health inspection stars. However, researchers found that their complaint investigation deficiency scores were actually worse than their recertification survey deficiency scores, which they say inaccurately depict the quality of those nursing homes. Specifically, the researchers found 19.7% of nursing homes with one star complaints ratings had higher recertification health inspection ratings, which gives the nursing home a positively skewed rating.

The study proposes consumers may be better served by the CMS rating system if complaints were assessed as a separate component of the Five-Star Quality Rating System.

Nursing Home Rating Problems

Nearly two years ago, The New York Times released a comprehensive analysis of nursing home ratings, which found 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 indicated the rating 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.

Aside from the occasional on-site inspections, the ratings rely heavily on self-reported data from the nursing homes themselves, the report found.

The New York Times indicated that 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.