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Federal Government to Improve Faulty Rating System

In recent months, there were reports that the federal government’s methods of rating nursing homes and long-term care facilities were deficient and resulted in inaccurate ratings of the quality of care at certain facilities. The federal government’s role in nursing home and facilities exists largely where federal funds go toward paying for the insurance of residents through programs like Medicare of Medicaid. The Centers for Medicare and Medicaid Services (CMS), which falls under the umbrella of the United States Department of Health and Human Services (HHS), is responsible for tracking the performance of nursing homes that receive federal dollars through Medicare or Medicaid, as well as handing down sanctions and maintaining lists of underperforming facilities.

The “Nursing Home Compare” website is the main source for this type of information for nursing home consumers and their families. One of the core reasons for the deficient ratings was the fact that many facilities were permitted to self-report certain data regarding the quantity and quality of care they gave to their patient residents.

Naturally, this implies that facilities may be more than likely to overinflate their own reporting, including statistics like staff levels. A key problem with facilities, though, is the low staffing levels used by owners and administrators in an effort to increase revenue and profit at the expense of attention to patients. There was furthermore information that went unverified. According to some, far too many homes received four and five-star ratings (out of five) that they likely did not deserve, and homes with a history of poor quality of care received rather high marks. Also, the prior ratings did not take into account the use of antipsychotic drugs to hold down irritable or potentially violent patients. Notably, between 2009 and 2013, the number of five-star rated homes increased from 11% to 29% of facilities nationwide under the previous rating paradigm.

In more recent news, the government has indicated that it will reform the way in which it rates nursing homes. The scoring criteria will be much stricter going forward, implying that certain facilities will see their ratings drop compared to the prior cycle of ratings. As the New York Times has reported, last autumn the government mandated that nursing home staffing levels be reported each quarter and compared against payroll data for verification, and planned to implement an audit to verify the “quality of care” statistics that were originally self-reported by the facilities.

This verification appears to largely hinge on increased visits by state agencies responsible for nursing homes, and which often facilitate the use of Medicare and Medicaid dollars. CMS’s examination of staffing levels ties into concerns about hours spent treating and helping patients, as well as medication levels. As reported, the government will also consider the added criterion of antipsychotic drug use – impliedly, more use could lead to a lower rating since antipsychotic drugs have become anathema to resident care, and slowly phased out in many homes. While some might worry that the presumptive lower ratings of homes would disturb consumers, others have noted that certain facilities still operate at a high level, meaning that the intended more accurate system will work.

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