Nursing Home Ratings Conceal Deeper Issues

A newly released investigation from Scripps News reveals a troubling reality: high ratings for U.S. nursing homes may not accurately reflect the quality of care issues and deaths occurring within these facilities.

In fact, numerous nursing homes around the nation are able to maintain the highest federal quality scores despite having records of serious incidents or failures in previous years.

High Ratings, Hidden Problems

The Scripps News report begins with the tragic story of a widower who lost his wife of 50 years after she was left unattended by staff while eating a sandwich at her nursing home in Spokane, Washington. According to an inspection report obtained by Scripps News, caregivers later failed to call 911 when they discovered the woman, who had a condition which made swallowing difficult and which required her to have caregivers present while she ate, slumped over but still with a pulse. The inspection report indicated that the facility, “failed to provide the level of supervision necessary,” “failed to provide all interventions necessary,” and “placed additional residents at risk for aspiration, choking, and death.”

Despite the woman’s death and the damning findings that followed, the nursing home was able to maintain the federal government’s highest 5-out-of-5 overall quality assessment score, which comes from the Five-Star Quality Rating System established and utilized by the Centers for Medicare and Medicaid Services, or CMS.

That discrepancy, Scripps News notes, is not unusual.

Under CMS’ Five-Star System, nursing homes are assigned an overall rating based on health inspections, a quality-of-care assessment, and a staffing evaluation. The score, which is available on tools like the government’s Care Compare tool, is intended to serve as a resource for consumers to compare nursing homes and find the ones that best meet the needs of their loved ones. Nursing homes with 5 stars are viewed as having far-above-average quality, while 1-star homes are those with quality much below average.

According to its review of more than 14,000 nursing homes across the country, however, the investigation found that hundreds of nursing homes continue to maintain or display high ratings despite also being found to have had a serious incident at their facility in the last three years.

Known as “immediate jeopardy incidents,” these incidents are those in which facilities are found by government inspectors to be noncompliant with federal health and safety standards. While some involve tragic deaths like the one at the Spokane nursing home, others involve incidents that generally place residents at risk for injury or death. Additionally, many nursing homes – like the Spokane facility in the story – implement corrective measures that allow them to maintain 5-star ratings.

In fact, the investigation found that nearly 250 of the nursing homes reviewed had 4-star or 5-star ratings despite also having at least one immediate jeopardy incident in the previous three years. Among the facilities reviewed, Scripps News found that one Pennsylvania nursing home was able to maintain a 5-star rating for over a year after one of its residents froze to death after staff failed to notice she was missing, and that another facility in Minnesota kept its 5-out-of-5 quality score for more than a year after one of its residents slipped away, purchased a knife, and committed suicide.

Reform for Nursing Home Ratings Systems

Apart from the problems CMS’ 5-Star System failed to capture, the investigation found other issues that reveal flaws in how we rate our country’s nursing homes. This includes a total lack of uniformity in how the federal government rates nursing homes in various states.

As Scripps News investigators found, even with the same health inspection findings, a 5-star-rated nursing home in one state might be rated much lower in another part of the country. That’s because the health inspection rating – which is the baseline for a facility’s overall rating – is assigned based on how a facility’s inspection findings compare to other nursing homes in the state.

According to Scripps News, there were nearly 400 nursing homes with 4- and 5-star ratings that would have just 1 star if they were rated against homes in a different state.

That inconsistency has sparked many advocates and lawmakers to push for much needed reforms. As Sen. Chuck Grassley of Iowa, a long-time proponent of nursing home reform, noted:

“You could be a 5-star and still have very poor quality of delivery of services to older people. If a nursing home is a 5-star, it ought to be the best you can go to, and it doesn’t matter whether it’s in Iowa or Arizona, it ought to be the same quality.”

While congressional leaders like Sen. Grassley have pushed CMS to add information to its Five-Star System that allows consumers to compare nursing homes nationally, the agency has yet to implement recommendations.

What Consumers Can Do to Protect Their Loved Ones

In the absence of an improved or unified rating system, consumers are forced to take steps themselves to ensure that the facilities they choose will be qualified and capable of providing the level of care their loved ones deserve.

If you are searching for a nursing home, be aware that you can’t rely on CMS’ ratings alone, just as you should overly rely on facility ratings left by residents or families on online platforms. Instead, you should look beyond the star rating and consider a range of information obtained through various means. This can include:

  • Visiting nursing homes in person
  • Speaking with administrators and directors
  • Asking questions specific to your loved one’s needs, including questions about protocols for patients with certain conditions and cognitive abilities
  • Getting feedback from residents or people with loved ones who live at the facility

Have a Nursing Home Abuse & Neglect Case? We Can Help.

Brown & Barron, LLC is an award-winning trial practice with a reputation for fighting on behalf of victims of nursing home abuse and neglect. As a firm that has seen the quality of care in U.S. nursing homes precipitously decline in recent years, and cases of neglect and understaffing, preventable deaths, and resident wandering increase, we encourage all families to carefully consider the facilities they choose for their loved ones and to do so without overly relying on the CMS Five-Star System, which may not provide a full picture of a facility’s record or overall quality.

Unfortunately, many families do rely on these ratings, as well as the marketing materials promoted by facilities that prioritize profits and payments to investor shareholders over their obligations to provide care – sometimes with tragic consequences.

As we continue to expose the failings in our nation’s nursing home industry, we also remain committed to helping victims and families fight for justice after suffering preventable harms and losses. This includes helping families explore options for pursuing civil claims that seek accountability and a fair recovery of damages.

If you have a potential case involving abuse, neglect, or exploitation at a nursing home or assisted living facility anywhere in Maryland, we can help. Give us a call at (410) 698-1717 or contact us online for a FREE consultation.

man sitting on nursing home bed
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