The good news: We are living longer. In 1919, the average life expectancy of an American was 53 years. Today, that number has increased by nearly 50% to 79. Aging, as we all know, brings changes. For some of us, that change may include living in a setting that provides 24/7 care.
Over 1 million residents live in our nation’s nearly 16,000 nursing homes. Anyone who has had to make the decision to move to a nursing home, either for oneself or for a loved one, knows the process can be stressful, emotionally fraught and confusing. When you find Nursing Home Compare, the online database operated by the Centers for Medicare & Medicaid Services, you’ll come to understand that nursing home care is regulated by a complex survey system that includes inspections and penalties.
On Oct. 7, CMS announced plans to implement a new consumer alert icon on Nursing Home Compare that will flag nursing homes that have been cited for abuse or neglect of residents. This icon, a palm-forward hand in a circle with a red background, is intended, CMS says, to “increase transparency” and “help consumers make the right decisions for themselves and their loved ones … by putting critical information at consumers’ fingertips.”
The problem is that the icon is misleading. The penalty system CMS uses to indicate a providers’ quality of care is highly nuanced. An icon simply cannot provide consumers with details on the subtle yet important variations in types of penalties. There is a significant difference between one levied for harm resulting from intentional mistreatment and one for harm that is the unintended consequence of a misguided action. But that distinction will be lost on most consumers.
To be clear, intentional harm, abuse and poor quality care cannot be tolerated. However, mistakes sometimes are made, whether in nursing homes, in hospitals or other care settings. Yet under the terms of this new initiative, the icon will be identical, even if the problem was not.
Our nonprofit members support transparency and efforts to help consumers identify and select the best possible care. But misleading information offered under the guise of transparency is useless to consumers and providers alike.
Consider this: An analysis conducted by our state partner of nursing home data in Minneapolis found that 12% of substantiated nursing home maltreatment reports fell into the abuse category. The vast majority of maltreatment instances were not the result of an intention to hurt the resident; they were the result of someone not doing a task correctly. While this should not minimize any instance, it does reinforce that there are distinct types of occurrences and that not all involve an intent to hurt the resident. True transparency would discern and explain the differences. This icon, which does nothing more than shout, “Stop! Do not proceed!” simply isn’t up to that job.
That leads us to the larger point: We oppose the use of this icon because it is built on the back of a flawed survey system in which interpretations of regulations are notoriously inconsistent. We continue to urge CMS to fix it. We seek to work with surveyors to develop a system that allows flexibility to target resources where they are needed to improve quality.
Nursing homes are a crucial component of the long-term care continuum. Our members provide loving care in spite of tremendous challenges, from workforce shortages to limited Medicaid reimbursement for services performed. Surely an effort aimed at providing transparency to consumers is not also intended to push providers closer to the edge of viability. What will those of us who need nursing home services do then?
Consumers, providers, policymakers and other stakeholders concerned about the care and wellbeing of older adults will never achieve the kind of transparent information system we all want -— and indeed should demand — without the creation of a meaningful quality assurance program.
Smith Sloan is president and CEO of LeadingAge, the association of nonprofit providers of aging services, including nearly 2000 nursing homes.