The federal government's five-star quality rating system for nursing homes has been scandalously easy for home operators to cheat by simply failing to report evidence of poor patient care.
That should change starting in January, when the Centers for Medicare & Medicaid Services imposes tougher reporting requirements nationwide. Reform is critical. The system, considered the gold standard in the industry since 2009, is used by families as a guide to safe, capable care for their loved ones. It needs to be trustworthy.
But the system's reliance on self-reporting without independent verification made scamming it too easy. For example, the Medford Multicare Center for Living got passing grades for years despite having 17 employees convicted of negligence and falsifying records since 2008. Seven others were charged in the 2012 death of resident Aurelia Rios, 72. The home currently has a middle-of-the-road three-star overall rating.
The ratings are based on three things: staffing levels; quality measures, such as how many patients developed bed sores or had serious falls; and the results of periodic inspections by state health officials. Of the three, only the inspections are independent assessments. The others rely on data reported by nursing homes.
Staffing levels are reported once a year, often in connection with an inspection. There is no way to detect if a home operator adds staff just for that period and reports those inflated numbers.
The administrator of the Medford nursing home allegedly said as much in 2010 in an email recounted in the New York attorney general's lawsuit against the home in February. Questioned about overtime hours, the administrator assured the home's owner that it was just for the state inspection survey. "All hands on deck during the survey," he wrote. "It's our superbowl and only lasts one week. The staffing hours will be a little high for this week but will drop the following week."
Self-reporting of quality measures also can be unreliable. Since 2008, only 60 of 5,000 incidents and accidents at Medford were reported as the law requires, according to the state's lawsuit.
The reforms announced last week will require homes to electronically report staffing levels each quarter. Officials will be able to verify the data against payroll records. That routine auditing should increase reporting accuracy. More important, it will prod homes to maintain appropriate staffing levels, which should result in better care.
Quality measures that homes must report will also be expanded. The first addition, starting in January, will be the extent to which anti-psychotic medications are used. Future additions will include data on re-hospitalization and discharge rates.
How the data are scored to determine a rating is also set to change. Independent information is already weighted higher than self-reported data. But starting next year, there will be even greater emphasis on data that are verified by independent sources.
It's too bad that top-quality nursing homes will be burdened with more reporting requirements. But they will help root out shoddy operators who put the lives of vulnerable elderly and disabled residents at risk.