Nursing Homes are Gaming the Medicare Rating System

A recent report in the New York Times shows how nursing homes are gaming the Medicare rating system. Medicare rates nursing homes on a “star” scale of 0 to 5, 5 stars representing the highest rating. The Medicare nursing home rating page can be found here. According to the New York Times’ report large portions of the Medicare rating system are based on self-reported data from the nursing homes. Additionally, state fines and enforcement actions aren’t considered in the Medicare rating system. One nursing home in California had a five star rating from Medicare even though it had numerous complaints and was fined $100,000 for causing a woman’s death.

Nursing homes make money based on how many residents they have, and so they have an incentive to make themselves look good, even when they’re not. The more residents a nursing home has, the more money they get from health insurance and Medicare / Medicaid. Consumers and doctors look at a good Medicare rating as a sing that the facility is a “good” nursing home that takes care of its residents, and are more likely to put their loved ones and patients there for care.

While the New York Times’ report may be eye-opening to many people, attorneys who represent injured nursing home residents and their families aren’t surprised. Sadly gaming the Medicare rating system is just another example of how nursing homes put their own profit over their residents. Nursing home attorneys see many cases where the nursing homes keep their staff numbers at a minimum to maximize overhead, fail to train their staff, or have staff with criminal records, leading to injuries that should have never happened in the first place. When nursing homes find out that state inspectors are coming, many will clean up their act and increase staffing, only to let things go back to the way they were when the inspectors leave.

This is not to say all nursing homes are bad places – there are many nursing homes that take care of their residents, have the right number of knowledgeable staff on hand, and keep their buildings and equipment clean.

If you or a loved one are considering a nursing home, get all the information you can. Read the Florida state surveys. See if there are any administrative actions against the nursing home. Tour the facility, talk to the staff, and ask questions. Once your loved one is a resident, visit them frequently and talk to the staff about their care. Doing these things can help prevent injuries and will help your loved recover in a safe and friendly environment.