Medicare Nursing Home Ratings Misleading?

The process of choosing a nursing home for your ill or aging family member is often times a difficult and time-consuming one. Everyone wants to ensure that their family member is well cared for physically as well as emotionally. Many people even spend months poring through brochures and informational booklets in an effort to find the best fit for their loved one. The Medicare star rating awarded to many nursing homes and assisted living facilities is frequently a determining factor in the search. People generally trust this rating and place a great deal of faith in the rating system. Unfortunately, Medicare’s ratings have been found to be awarded based on incomplete or inaccurate information.

The New York Times recently examined the Medicare rating system, which rates over 15,000 nursing homes across the country on a scale from one to five. Evidently, the ratings are based primarily on unverified, self-reported data. Of the three factors used to determine a ranking, only one-the results of annual health inspections-relies upon independent evaluation. The other two factors-staff levels and quality statistics-are self-reported by each nursing home and generally accepted at face value by Medicare.

Oddly, the ratings system does not account for several other important factors, such as quantity or severity of state fines, number of consumer complaints filed with state agencies, and the number of lawsuits filed against a facility. Each one of these factors, however, is potentially more significant than a nursing home’s staff levels or quality statistics. Thus, a five star Medicare rating could be misleading residents and their family members as to the true nature of the facility. As reported by the New York Times, “of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics,” which improves their overall rating. Consequently, a facility could inflate their staff numbers to earn a higher “staff level rating” in order to improve its overall score. The result is a number of nursing home facilities with excellent staffing numbers are being awarded overall score of four- and five-stars even though other serious issues exist at the facility.

While Medicare ratings can give some indication of a facility’s overall status, there are many other factors to consider when choosing a nursing home for you or your loved one. As previously stated, it is important to look into state fines and disciplinary actions as well as state consumer complaints. In addition, it is helpful to get a more personal feel for a facility by going to visit and interact with the staff members. That way you will better understand the quality of care being provided.

If you or your loved one did not take the above precautions before selecting a nursing home and ultimately suffered some form of nursing home abuse or neglect, call The Higgins Firms today to discuss your legal options.