Critics say Medicare’s Nursing Home Ratings are Deeply Flawed

Posted on: August 26th, 2014 by Mark R. Friedman

The New York Times released a report and editorial this week criticizing Medicare’s nursing home ratings system, saying Medicare’s nursing home ratings were deeply flawed and could mislead consumers.

Medicare maintains a database called Nursing Home Compare, that assigns star ratings similar to hotel reviews, with one star being lowest quality and five stars being highest.

The ratings take into account metrics like staffing and quality statistics. However, the Times says that these statistics are reported by the nursing homes themselves, who obviously have an incentive to report more favorable statistics, and are taken more or less at face value by Medicare.

The Times also criticizes Medicare’s ratings for failing to take into account negative information collected by the states. For example, the ratings consider fines imposed by federal regulators, but not state regulators. The Times cites as an illustration a nursing home in California, which has had no federal fines, but was fined $100,000 by state regulators for causing the death of a resident, and for which the state has received more than 100 complaints. Medicare awarded the nursing home a five-star rating.

My advice to consumers looking for an appropriate nursing home for a loved one, is that Medicare’s database may be a good starting point, but take it with a grain of salt. The database includes detailed information on inspection reports and federal violations, but it is missing quite a bit of important information. You should always tour a nursing home, speak with staff, and observe how residents are treated. You may also find it helpful to work with a geriatric care manager.

(Consumers may also wish to look at ProPublica’s nursing home violations database, including ProPublica’s New Jersey nursing home violations chart. ProPublica’s database is based on Medicare’s data, so the same caveats apply.)

If you or a loved one may soon need long term care in a nursing home or other facility, we are happy to work with you to find and fund appropriate placement.  See our Practice Areas and Q&A pages for more info, or call us today at (908) 704-1900 to make an appointment.

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