Medicare’s Nursing Home Rating System Needs an Overhaul. Are Lawsuits the Way?
Posted on Sunday, August 1st, 2021 at 1:31 pm
Millions of Americans rely on nursing homes and long-term care facilities to provide compassionate medical and emotional care to their loved ones. Family members have increasingly turned to the internet to compare nursing homes, read reviews, and look at ratings to help them determine which facility is the right fit. Unfortunately, the numbers don’t always tell the whole truth. Although changes have been proposed and legal proceedings are in the works, are lawsuits the only answer to the problem?
Twelve years ago, the U.S. government rolled out an online tool that was supposed to help family members compare nursing homes using an easy-to-understand star-rating system. One star signified a poor rating, and five stars meant the facility was great. This system is the Centers for Medicare & Medicaid Services Five Star Rating System. Another website, the Nursing Home Compare website, is a companion site that helps users explore and compare the different aspects of nearby nursing homes.
In 2016, a government watchdog agency called the Government Accountability Office or GAO conducted a study on the effectiveness of these websites and determined that they left something to be desired. The agency identified several areas where the sites fell short. The group specified factors that inhibited the rating system and made choosing between high and low-performing nursing homes difficult and confusing.
Fast forward to March of 2021, and it seems the GAO recommendations may have been largely overlooked or the CMS system vastly overestimated. The New York Times published a bombshell piece suggesting that the CMS Five Star Rating website relies heavily on self-reported data from the nursing home itself. Self-reported data is iffy at best and can be manipulated to hide deficiencies and shortcomings.
The New York Times piece also highlighted problems in Kentucky facilities that utilized the rating system. One Kentucky family who selected a nursing home using the online tool was shocked when their loved one ended up suffering abuse and neglect in the form of being made to lie in her own feces. Caregivers also left her surgical wound untreated.
That brings us to today. On July 2nd, 2021, Sen. Chuck Grassley (R-IA) called on the GAO to again conduct a review of both the CMS Five Star rating system website and the Nursing Home Compare site. Statistical data still shows major disparities in the system, which skew results and may give individuals looking at nursing homes a false sense of security about the facility they choose.
While some states wait for Senators like Grassley and agencies like the GAO to take more action, other states are taking the fight directly to the nursing homes. California recently accused one of the country’s largest nursing home chains of manipulating the rating system and providing false information and is taking the company to court. The lawsuit has been filed by California’s attorney general and district and city attorneys in the state. It accuses the chain, Brookdale Senior Living, of illegally discharging patients to free up beds for higher-paying residents and giving false information to regulators to boost their online CMS rating.
This is the first high-profile case being brought to court over the issue. It is interesting to note that the chain is a $4 billion company that operates almost 800 nursing homes across the country, including facilities in Kentucky. Brookdale is denies any wrongdoing.
When you choose a nursing home, you want quality and care to come first, but it is hard to determine quality when the system is rigged. Poor performing facilities may be inflating their ratings only to leave your loved one abused or neglected. It will be interesting to see how the California case plays out in court. Ultimately, it may take legal action and the threat of losing money for some facilities to stop allegedly gaming the system.
If you suspect your loved one is being neglected or abused in a Kentucky nursing home, contact the Lexington nursing home abuse attorneys of Hare, Wynn, Newell & Newton, LLP for help. We are deeply committed to fighting for your family and getting your loved ones the compensation they deserve. Contact us today for a free consultation by calling (859) 550-2900.