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Medicare Nursing Home Star Rating System Investigated

Doctor with elderly patientThe term “five star rating” when applied to a hotel conjures up visions of fluffy white towels and soft cotton robes, polished marble floors, and white glove service with a smile. In a sizzling report on nursing home Medicare star ratings, The New York Times found a five star rating also applies to a nursing facility where a coroner’s report on a dead resident detailed “bedsores that had become so bad, they had developed gangrene and were infested with maggots”.

The deeply disturbing August 24 Times report came as no surprise to the New Jersey nursing home abuse lawyers at Eisbrouch Marsh who have followed the manipulation and abuses of the Medicare nursing home star rating system since its inception in 2009.

Consumer groups applauded the system at the time because they felt that regular inspections would provide an incentive to operators to maintain their facilities and services at the highest level. The reality of how the system works became a mockery of the star system itself.

High star ratings equal higher profits for nursing home operators

The Medicare star system, which has become the gold standard in the industry, is widely used by unwitting consumers who have no other guidance when choosing a home for a loved one. Insurers and investors also rely on it for lack of a better alternative. Out of 15,000 nursing homes nationwide, 3,000 are rated “five stars” in three categories:  staffing, quality measures, and health inspection.

The flaw is that Medicare relies on the nursing homes to self-report on how they staff their own facilities and how well they adhere to quality of care standards.  The data is accepted by Medicare at face value, and the stars are awarded accordingly. Only the health inspection is done by an independent reviewer.

The ratings also do not take into account complaints filed by consumers with state agencies, fines, or enforcement actions by the state. The Times article focused on a California nursing home, Rosewood Post-Acute Rehab, which is consistently awarded a five star rating but received 164 consumer complaints between 2009 and 2013, twice the state average, according to the California Advocates for Nursing Home Reform. 

New Jersey nursing home abuse lawyers are industry watchdogs

As can be expected when profit is the motivator, the Times’ investigation has found that many “top-ranked” nursing homes have found ways to game the rating system. In the days before the staffing inspection period starts, more employees are brought on, only to be let go after the inspection period ends, resulting in a four or five star rating in the staffing category.

According to the Times article, the staffing inspection period was described by a nursing home official on Long Island as “our Super Bowl”. In an email presented at trial in a lawsuit filed against the home by the New York State Attorney General, the administrator of the Medford Multicare Center for Living wrote, “The staffing hours will be a little high for this week but will drop the following week” referring to the inspection period. 

Little or no Medicare auditing of inspection results

The self-reported “quality measures” category, based on data like how many residents experience falls or whether bedridden patients are experiencing bedsores, is also ripe for manipulation. There is no Medicare auditing of the reported data so the homes are free to submit what they wish. 

Not surprisingly, the Times reported that homes routinely scored four or five stars in the self-reported categories, but more than 95% scored only one or two stars for the independently scored health inspection category.

Call NJ nursing home neglect attorneys

If you or a loved one has been the victim of neglect or abuse in a nursing home, call Eisbrouch Marsh now for a free consultation. Our attorneys boast a long track record of successful verdicts and settlements involving nursing home abuse throughout New Jersey. To learn more about your legal options, call 201-342-5545

  1. NJ.com, Several Monmouth County Nursing Homes Get 5 Star Rating http://www.nj.com/monmouth/index.ssf/2014/03/several_monmouth_county_nursing_homes_get_5-star_rating.html
  2. State Of New Jersey Department of Health, Consumer Reports and Resources, Nursing Homes http://www.nj.gov/health/reportcards.shtml