State Rankings Paint Inaccurate Picture of Quality of Care in Nursing Homes

Previously, I blogged about the ongoing saga of Medford Multicare Center for Living, located on Long Island. A lawsuit, the highlight of which is the death and alleged cover up of an elderly woman at Medford, was filed by New York State Attorney General Eric T. Schneiderman. The Attorney General claims there is a history of neglect and mistreatment at Medford. These accusations are surprising because recent state rankings of the nursing home don’t reflect these claims of poor treatment.

According to two Newsday articles (one by Ridgely Ochs and Chau Lam and the other by Joye Brown), Medford Multicare Center for Living received an overall ranking of 3 out of 5 stars on a federal website, Medicare’s Nursing Home Compare, that provides detailed information about Medicare and Medicaid-certified nursing homes. Last year, the nursing home received a ranking of 4 out of 5 stars for health inspections and quality of care. If the Attorney General’s allegations are true, this average ranking in no way reflects the quality of care at Medford.

New York State’s Department of Health conducts inspections, collecting data used to rank nursing homes throughout the state. However, nursing homes themselves gather and report the statistics used for ranking. This data is not required to be reviewed, so the is no way to determine its accuracy. This self-reporting creates a conflict of interest that can lead nursing homes to inflate or even completely falsify the data they report.

In her Newsday article, Joye Brown quotes Charlene Harrington, a professor of nursing at the University of California, San Francisco. Harrington explains, “The rating system is based on three things: First, deficiencies: If those aren’t issued properly, then you can’t rely on that. Second, staffing: Nursing homes can gin up those numbers when they suspect surveyors are coming. Third, they can falsify quality measures.”

According to a paper by the Kaiser Commission on Medicaid and the Uninsured from 2013, the Affordable Care Act requires nursing homes to increase their transparency. The Centers for Medicaid and Medicare Services (CMS) has already implemented a number of new requirements, including improving the collection of data on owners and managers and providing links to health inspection reports. However, other important provisions have not yet gone into effect.

With the Attorney General’s surprising allegations, it may be time to rethink the way we assess and present the quality of care and safety at nursing homes. The public relies on these ratings to make difficult decisions for themselves and their loved ones. Verifiable data needs to be easily accessible and used in the ranking process, so ratings represent the truth about nursing homes throughout New York State.