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Nursing Home Quality Assurance: Maintain the Momentum

Follow Up to New York Times Report Highlighting Another Limitation in Medicare’s Rating System
Would You Hail A Cab With A Flat Tire?   Part 5
A recent New York Times article "Nursing Homes Routinely Mask Low Staff Levels" is important. It raises an awareness regarding the limitations of Medicare's Nursing Home Compare resource utilized by consumers and professionals across the country. Incorporating self-assessment with a tool structured to measure quality compliance is by design fraught with the temptation for abuse, especially when it impacts on the bottom line.
Credit needs also to be rendered to the original researchers who brought the problem to light and spurred the change in the system to utilize payroll records: Professors Xu Han Florida Atlantic University, Niam Yaraghi, University of Connecticut and the Brookings Institute,  and Ram Gopal University of Connecticut. Their study, entitled Winning at All Costs: Analysis of Inflation in Nursing Homes’ Rating System analyzed data from over 1200 nursing homes in California. Published in 2017, “We argue that the rating system is prone to inflation in self‐reported measures, which leads to biased and misleading ratings.”
Moreover, as noted in our previous newsletter, CMS’ 5-Star Rating System needs to be replaced.

The term “5-Star” implies outstanding service and performance. 

Nursing homes with the five-star rating, however, are not necessarily excellent. Facilities touting five stars may have issues not reflected in the ratings. Examples of family experiences include extensive delays in obtaining nursing assistance, incorrect medications instructions upon transfer to the hospital, obstacles in receiving timely medical care.

Reviewing the New York Times report highlighting flaws in the rating system, gerontologist Cathy Cress, MSW posted
" The government has been party to this by coming up with their star rating, giving five stars like a Michelin rating to what they considered great nursing homes. But these stars were not verified by inspections on a regular basis or payroll records, and staffing was self-reported…

This is not like having a poor meal at a five-star restaurant. This is like putting your mother in a place that the government says has great care and having her die of neglect.”
Medicare seems to respond to its own self-assessment.They no longer rely on self-assessment to determine and compare staffing ratios. 

Shouldn’t we keep up the momentum and advocate strongly that they replace “5-Stars” with some other scale?

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