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COVID-19 exposes flaws in nursing home rating system

A New York Times in-depth investigation has uncovered a significant disparity in the quality of care by thousands of U.S. nursing homes and the star rating system that grades them.

In many cases, the Times found that nursing homes were ill-equipped for the coronavirus pandemic and spent more time trying to improve their scores instead of upgrading the care they provided to residents.

How is a star rating determined?

The U.S. Centers for Medicare & Medicaid Services (CMS) established the star rating service in 2009 to help families choose the best nursing care for their loved ones, with five stars the best and one star the worst. The system relies on self-reported data from over 15,000 nursing homes and in-person inspections from state investigators. Scores are based on three grades over:

  • How much time nurses spend with patients
  • How facilities fare in inspections
  • The quality of care for residents

Those grades are combined into the star rating for each nursing home.

Data often manipulated for rating facilities

The Times studied the reliability of these ratings by examining more than 370,000 state reports and financial statements of more than 10,000 nursing homes. They also gained access to data not available to the public. Their key findings include:

  • Much of the information sent to the CMS is skewed, making nursing homes appear to be cleaner and safer
  • Some facilities intentionally misreport staffing levels, including employees on vacation as on-duty
  • Resident accidents and health problems often go unreported
  • Some nursing homes earning five stars are just as likely to fail in-person inspections
  • Nursing homes are often warned in advance about “surprise” inspections
  • Inspectors uncover evidence of abuse and neglect, but ratings are rarely lowered
  • Of the more than 3,000 nursing homes with five-star ratings, more than 2,000 had issues with patient abuse or infection control

Report shows nursing homes were unprepared for pandemic

Nursing home residents have been some of the most vulnerable to the COVID-19 pandemic. More than 130,000 residents have died from the virus. The Times’s investigation found that people residing at five-star facilities were nearly as likely to die as those living in one-star nursing homes.

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