Nursing homes inflating self-assessments to improve Five-Star ratings, study claims

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Investigators from the University of Connecticut report that at least 6% of nursing homes inflate their self-reported measures — “most often the larger and for-profit facilities that stand to gain most financially by improving their scores.”

Their study of 1,200 California nursing homes examined data from 2009 through 2013 and was published this week by the National Institute for Health Care Management Foundation. The Connecticut business professors reviewed measures included in facilities' Five-Star ratings and other information from Medicare files, as well as information on facility finances and resident complaints.

They also looked for correlations between standards-based inspection reports and the self-reported ratings to determine consistency.

One clue that some facilities have been overstating quality improvements they've made? The authors say the number of resident complaints is similar for nursing homes with the same objectively derived inspection rating, but it varies significantly between facilities with the same overall rating, suggesting inflation.

“Often the decision to move a loved one into a long-term care facility is a very difficult one, and families rely on these ratings to provide the most accurate information possible about their choices,'' said co-author Niam Yaraghi, a professor of operations information and management, and a non-resident fellow at the Brookings Institution's Center for Technology Innovation. “Although a relatively small number of the approximately 15,000 U.S. nursing homes seem to inflate their score, it is a disservice to patients and families alike.”

The American Health Care Association said consumers should always use multiple resources to determine a facility's quality.

“Nursing Home Compare, and the information it contains, is just one source that people can use to get an understanding of the care a facility provides,” said Beth Martino, AHCA's senior vice president of public affairs. “Visiting facilities in person and spending time there is one of the best ways people can obtain firsthand information (about) the care provided.”  

Study authors said they hope their findings help Medicare improve its inspection process and remove some subjectivity from its ratings system.