Nursing Home Compare is a website run by Medicare.gov under the umbrella of the United States Department of Health and Human Services. It is a website intended to make it easier for prospective nursing home residents and their loved ones to research the performance histories of facilities in their area, including investigation information, previous sanctions, and other ratings that can help inform these prospective consumers. (State health and aging agencies also responsible for gathering this type of information.)
Center for Public Integrity Report
The Center for Public Integrity, however, has recently called into question the reliability of information provided by Medicare through the Nursing Home Compare website. It conducted an investigation that has revealed that the Nursing Home Compare information from Medicare does not seem to accurately reflect nursing home staffing levels. One particular problem was that 2005 Medicare cost reports from nursing facilities indicate lower staffing levels than what Nursing Home Compare reported. The inaccuracies were particularly pronounced as to registered nurses among the various other staff titles. Approximately over 80% of facilities reported higher registered nurse staffing levels than was reported directly to Medicare.
Fittingly, the Public Integrity articles on the matter indicate that these cost reports were “hard-to-locate” by the public, and were not relied on by Nursing Home Compare in performing official investigations and reforms even though they showed low staffing “in thousands of cases.” Notably, greater than a quarter of nursing homes across the country more than double their self-reported staffing levels as compared to the Medicare reports, which the facilities must assume no one will truly look closely at given the difficulty for the public to acquire and examine them.
Part of the problem seems to be that the Nursing Home Compare information is derived from investigations by state surveyors which gather self-reported data from nursing homes over a two week span before federal inspections are conducted by HHS and CMS to ensure compliance with federal and state regulations. Naturally one would stop and wonder how self-reported data would be all that reliable given nursing homes would be incentivized to inflate numbers, and even provide the image that staffing levels are higher during the time of inspection just to avoid sanctions. It is unclear why a federal website would not cite to seemingly available Medicare reports instead of not-as-easily-verified self-reported data from the facilities.
In addition to the general problem of grossly inaccurate staffing levels, out of the ten states with the largest reporting discrepancies, eight of them are in the South. Louisiana and Arkansas, and Baton Rouge and Memphis, were states and cities that stood out in particular. The Public Integrity report also discovered that the Centers for Medicare and Medicaid Services had previously acknowledged, as far back as 2001 (13 years ago!), the inaccuracies and committed to gathering more accurate data regarding nursing home staffing. However the agency still has not acted on this and it is unclear just how soon it will.
Of course, as one might think intuitively, staffing levels are correlated to the quality of care given to residents, because adequate care requires consistent attention. And lower staff levels and less attention can lead to numerous problems, such as residents getting injured, not being cleaned, missing medications, and becoming malnourished and dehydrated, among other dangerous and even lethal possibilities. It is disconcerting that a federal website responsible for providing important consumer information has not relied on the most accurate data available, even when its officials and employees have publicly acknowledged the discrepancies in staffing levels. Hopefully it will follow through on its commitment to do a better job going forward.
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