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Nursing Home Rating System is Broken

By Rheingold Giuffra Ruffo Plotkin & Hellman LLP

The year of the COVID-19 pandemic has not been kind to the nursing home industry. First, Governor Cuomo’s administration has become embroiled in a controversy concerning the industry that could lead to the Governor’s impeachment. Second, the pandemic has shone a spotlight on the dangers of nursing homes including under staffing, poor sanitation, and elder neglect. Finally, the NY Times has published an article that demonstrates serious deficiencies in how nursing homes are rated in this country.

The Times’ authors write, “Twelve years ago, the U.S. government introduced a powerful new tool to help people make a wrenching decision: which nursing home to choose for loved ones at their most vulnerable. Using a simple star rating — one being the worst, five the best — the system promised to distill reams of information and transform an emotional process into one based on objective, government-blessed metrics.

The star system quickly became ubiquitous, a popular way for consumers to educate themselves and for nursing homes to attract new customers. During the coronavirus pandemic, with many locked-down homes unavailable for prospective residents or their families to see firsthand, the ratings seemed indispensable.

But a New York Times investigation, based on the most comprehensive analysis of the data that powers the ratings program, found that it is broken.”

The majority of elderly are relegated to live their final years in nursing home residences that are unsanitary, unsafe, and can be hotbeds for abuse and neglect. A few generations ago, family members took care of their own elderly in their homes but times have changed and economic circumstances (with both spouses working) that option is often no longer possible.

“More than 130,000 nursing-home residents have died of Covid-19, and The Times’s analysis found that people at five-star facilities were roughly as likely to die of the disease as those at one-star homes. The ratings program, run by the U.S. Centers for Medicare & Medicaid Services, relies on a mix of self-reported data from more than 15,000 nursing homes and on-site examinations by state health inspectors. Nursing homes receive scores based on how they fare in those inspections; how much time nurses spend with residents; and the quality of care that residents receive. Those three grades are then combined into an overarching star rating for each nursing home.”

However, the data can be skewed and manipulated and that is precisely what the Times’ investigation found. At the Hubert Humphrey Building dedication, November 1, 1977, in Washington, D.C., former vice president Humphrey spoke about the treatment of the weakest members of society as a reflection of a government: “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped.”

If what Vice President Humphrey is correct, we aren’t doing so well.

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