Aging Options

Nursing Home Rating System Plagued with Inaccuracies, Says Report

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Since 2008, consumers searching for the best quality nursing care facilities have relied on a 5-star rating system on the “Nursing Home Compare” website maintained by the U.S. Government (that website is located here – it allows you to search and review nursing care facilities by zip code or locale). The site includes a rating system of between one and five stars (five being best) for the categories of Health Inspections, Staffing, Quality Measures and an Overall rating. Many seniors and their families rely on this service for information that is supposed to be objective and honest.

But it turns out that some of the ratings are bogus, or wildly exaggerated, based in part on nursing home self-evaluation, a practice that has been shown to be seriously inaccurate in several key areas. Two years ago the New York Times reported that nursing homes were manipulating the data (“gaming the system,” according to the Times) such that “even nursing homes with a history of poor care [ had been rated ] highly in the areas that rely on self-reported data.” Now a new study done by the Centers for Medicare and Medicaid Services (CMS) reveals that little has changed. We found this disturbing report on the website of the Center for Medicare Advocacy, explaining how pervasive this practice is. Consumers need to beware.

The idea of a website to enable potential residents to search out and evaluate nursing homes goes back 20 years to the time of the Bill Clinton administration. The five-star rating system was launched in 2008. Recent studies have shown that a rating of five stars definitely increases occupancy while the lowest rating, one star, drives would-be residents away. But there’s a big difference in perception between a one-star facility and one that has a two or three-star grade, so it’s easy to see why nursing home operators would have a powerful incentive to boost their lowest ratings in order to attract move-ins. Sadly however, with the data appearing to be so flawed, it leaves many consumers in the lurch when it comes to evaluating care options.

In order to test whether nursing homes were complying with accurate rating standards, the CMS began by checking the ratings of nursing home facilities which had already been identified as sub-standard. Every month CMS and state officials single out those nursing facilities that are providing the poorest care to residents, labeling them SFF’s or Special Focus Facilities. Each SFF is placed under more rigorous scrutiny by Medicare and Medicaid inspectors until discrepancies and shortcomings are corrected. As part of their evaluation of the rating system, the CMS selected 42 Special Focus Facilities – all of which should have had very low ratings (one star) on the Nursing Home Compare website – and checked to see how they had evaluated themselves. The results were eye-opening. Of the 42 suspect nursing homes, almost all had received a one-star rating on their Health Inspections, yet many had overall ratings of two or three stars, indicating they were giving themselves far better evaluations than they deserved in the areas of Staffing and Quality Measures, which are self-evaluated. Many of these facilities, considered operationally sub-par by the government, had given themselves ratings of four or five stars in their self-evaluations in order to avoid an overall one-star quality rating. They were still “gaming the system.”

The Center for Medicare Advocacy considers this troubling for two reasons. “First,” says the article, “it continues to demonstrate manipulation of the federal website. Second, it moves facilities with one star in health surveys into a two-star overall rating.” The practice of facilities boosting their overall scores by reporting unrealistically high staffing and quality measures is being done solely to prevent “the stigma of being a one-star facility,” which drives away business. The net result: evaluation scores that “seriously mislead the public.” The sobering conclusion is that “composite scores do a disservice to the public when nursing facilities’ self-reported information boosts facilities’ ratings into higher levels.”

Getting objective information about retirement decisions is definitely a challenge. Here at AgingOptions, we want to be your objective guide as you make a whole host of retirement-related decisions, including choosing where you will live. If you need advice on how best to evaluate nursing facilities, assisted living options or any senior housing choices, contact us and we can help you by providing sources of information you can trust, not ratings systems manipulated by salespeople and marketing agencies! And for all your retirement planning considerations – finances, legal affairs, family communications and medical protection – we encourage you to explore the comprehensive process we call LifePlanning. Your LifePlan becomes your blueprint to help you build the secure and satisfying retirement of your dreams.

To learn more about LifePlanning, and about other vital facets of retirement preparation, we invite you to attend a free, no-obligation LifePlanning Seminar, offered at locations throughout the area. Click on the Upcoming Events tab on this website for dates, times, locations and online registration. Or contact us during the week and let us assist you. It will be a pleasure helping you make smart choices as you plan for your retirement future.

(originally reported at

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