How Nursing Homes With Five-Star Ratings May Be Hiding Dangerous Problems

No single event has brought as much attention to the substandard quality of care in U.S. nursing homes as the pandemic. Now it seems that even the highly influential star system used for ranking the quality of care provided by a nursing home is being called into question.

PKSD shares the New York Times article that details how long-term care facilities across the country were able to manipulate this rating system and deceive the public.

What is The Star Rating System?

The star system was introduced in 2008, just 12 years ago, to help families more easily research and locate nursing homes for elderly loved ones. The ratings are from one to five stars – with one star being the lowest and five stars the highest.

Consumers loved the star system for its ease of use and for the indispensable information it seemed to provide. Lawmakers hoped it would help prevent falling standards of care in the many facilities being bought out by private equity firms.

What Were Nursing Homes Rated On?

Long-term care facilities were assigned star ratings in three basic areas, including:

• Health inspection scores – which includes the number and type of citations a facility received, along with many other details
• Number of staffing hours spent per resident – this data is captured separately for licensed nurses, registered nurses, aides and more
• Quality of care consistently provided to residents – includes the type of stay and the medical condition of those in their care

Other metrics, including resident wound care, new or worsened pressure sores, the number of falls with a major injury and more, are all part of the metrics inspected and tracked by the Centers for Medicare and Medicaid Services (CMS).

Who Really Benefits From the Star System

The system was an instant hit with both consumers and the long-term care facilities that benefited from it. Consumers raved about having an easier way to research and find quality long-term care for their loved ones, while facilities with higher ratings benefited from the significant profit margins.

For example – in 2019, five-star facilities reportedly earned $2,000 in profits per bed, and even three or four star-rated facilities averaged as much as $1,000 in profits per bed. Facilities ranking below three stars operated at a loss.

Unfortunately, the star system’s reliability is questionable since the data is largely self-reported. Facilities are able to manipulate their reports to increase their profits, while misleading the public with exaggerated levels of care.

Data is Self-Reported and Rarely Subject to Audits

Several Medicare advisory board members addressed concerns about this fact not long after the system launched, cautioning federal officials that a rating system based on self-reporting could result in many facilities manipulating or falsifying their reports. For this reason, several board members recommended more frequent audits of the self-reported data.

Unfortunately, 25 former government officials, congressional aides, nursing home executives and elder-care advocates, who regularly meet with officials at CMS, said that audits rarely take place. In fact, no further action was taken even in situations where inspectors found evidence of fudged reports.

Impact on Nursing Home Residents

As always, it is the nursing home residents who suffer the most, and too often, with fatal results. Underreported data is misleading to families seeking quality care for their elderly family members. The greater impact of facilities placing profits over quality of care resulted in disturbing findings, including:

• Falls: University of Chicago researchers found that nursing homes, from 2011 to 2015 neglected to report approximately 40 percent of serious falls that caused residents to be hospitalized.
• Bed Sores: Integra Med Analytics, in a study conducted last year by their independent team of analysts and researchers, revealed that as many as half of all nursing homes underreported bed sores by at least 50 percent.
• Neglect/Abuse: The inspector general for the U.S. Department of Health and Human Services discovered long-term care facilities reported only 16 percent of incidents involving the hospitalization of residents due to potential neglect or abuse.

In the worst type of situations, residents suffer from severe neglect, abuse, even rape, as one patient learned all too well – even in a facility with a five-star rating.

In 2019, a resident was followed by a caregiver as she used her wheelchair to push herself back to her room from the kitchen. Once there, the employee forced her onto her bed and raped her. However, the attack was merely classified as a “category F” violation. Because this violation is rated as a low-level concern, or one that caused potential, but no actual harm, this facility – Reo Vista in San Diego – was able to keep its perfect five-star rating.

Our Experienced Lawyers Are Prepared to Help

Our team of knowledgeable nursing home abuse lawyers in Wisconsin are dedicated to protecting the elderly in nursing homes. If your loved one suffered because of neglect, abuse or willful misconduct by a caregiver or facility, we are prepared to help.

Contact PKSD law offices anytime, night or day, to schedule a free case review. There is no risk or obligation, and your meeting with the attorney is completely confidential.

PKSD Law. Legal Help When You Need It. 414-333-3333