Tougher Standards Change Ratings for Nursing Homes

For a long time, nursing home ratings have been criticized as inaccurate and inflated, so last month federal officials recalibrated the standards by which they are judged for quality. As a result, the ratings fell for nearly 1 in 3 such facilities in the U.S.

As explained by the New York Times, three criteria are the most important in driving the ratings on Medicare’s Nursing Home Compare website, and the changes concerned primarily one of them. Nursing Home Compare measures more than 15,000 nursing homes with a scale of one to five stars, using information gathered on every patient. Medicare officials reported that the website gets 1.4 million visits annually.

The feds said the revision should help consumers compare facilities better, and also inspire nursing homes to improve their care.

The Times said Nursing Home Compare had become the gold standard for evaluating the nation’s nursing homes, despite its critics, who decried the fact that it relied on information given by the facilities themselves, and was unverified by independent monitors.

Last year The Times published a story about homes that earned top ratings but that also had documented histories of poor quality care, and that the self-reporting was the root of the problem. (See our blog about what can happen when nursing homes escape oversight.)

“Two of the three major criteria used to rate operations – staffing levels and quality measures statistics – were reported by the homes and not audited by the federal government,” according the latest Times story.

In October, the government announced that it would being requiring nursing homes to report their staffing levels quarterly via an electronic system through which payroll data could be verified. The feds also said a national auditing program would be implemented to assess if a facility’s quality statistic was accurate.

Before the change last month, about 8 in 10 of the nation’s nursing homes garnered four- or five-star ratings for quality, according to The Times; afterward, only about half were rated that high. And the number of homes that got one star for quality went from 8.5 to 13 in 100. The staffing scores for 13 in 100 homes declined after the recalibration.

Although it’s disappointing and alarming to know that so many nursing homes fall short, it’s always better to know the truth than to be lulled into a false sense of security.

The rating system was implemented in 2008, and officials said the more rigorous standards reflected improvements in the industry. Thomas Hamilton, Medicare’s director of Survey and Certification, told The Times, “We expect improvement over time. … Just like the Model A [automobile] in its day was – I’m told – an excellent car, it wouldn’t measure up to today’s models.”

Of course, people who run for-profit nursing homes weren’t happy, claiming that the revised standards would frustrate, not assist, consumers, because so many of the facilities’ ratings were changing so drastically.

Instead of blaming the system, maybe they could ensure the accuracy of their data, and the quality of their care.

For information about nursing home neglect and abuse, see our backgrounder.

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