Nursing homes could be subject to worse deficiency outcomes — which could lead to fines and a decreased star rating — if an ombudsman is present during annual surveys, according to new research. 

Investigators with Penn State and Miami universities found that the presence of an ombudsman was linked to a 3.9% increase in the number of deficiencies and a 5.9% increase in deficiency scores. Deficiencies for quality of life and administration were affected the most.

“The additional deficiencies can cause nursing homes to face monetary fines or cause a nursing home that is just above the threshold for a certain star rating on the Nursing Home Compare website to lose a star (e.g., going from 5 to 4 stars),” the researchers wrote. “All of these can financially harm the NH and result in fewer resources that could be used to improve quality.”

Researchers focused on four types of deficiencies: all deficiencies, quality of care, quality of life and administration. They then analyzed U.S. nursing home survey data between 2009 and 2015. The data included 95,237 surveys from 14,996 nursing homes.  

An ombudsman was present for about 30% of surveys nationwide, the study found. 

The findings were published in the October issue of the Journal of Post-Acute and Long-Term Care Medicine.