Those more fortunate families can travel miles, passing ten skilled nursing facilities, in order to secure a bed at a 5-star nursing home. Studies indicate that the Care Compare tool has worsened this trend by equipping the more fortunate with greater knowledge. Sadly, those with fewer opportunities become entrenched in a cycle of lackluster care. In this way, those who already have access to high-quality facilities use the tool to dig in and continue to support (and fill) those more “ideal” locations. They choose the ones closest to them, which usually rank lower than average, and so receive lower quality care than their peers. The people who live there-who tend to disproportionately be people of color or individuals lacking online fluency, such as older folks-are less likely to be aware that the Care Compare tool exists, and so they cannot make informed decisions about which nursing homes to trust. As a result, fewer informed people choose to go to these facilities, which keeps the area low in income, and thus, opportunity.

First, nursing homes in low-income areas are more likely to receive a low score. The cause of this phenomenon comes from multiple places. In essence, underserved communities are less likely to find high-quality nursing homes because they are not aware of the tool, which only worsens service in their area, and the cycle continues. The other primary issue discovered with the use of the CMS 5 star rating tool is that it has unintentionally exacerbated the disparity of race and Medicaid status in high-quality nursing homes. The Racial Gap Widens in Nursing Home Care The facility’s focus becomes on gaining another star not on resident wellbeing. Thus, a nursing home’s rating may go up with almost no tangible change to the safety of the facility or the robustness of the care that they provide. This encourages facilities to achieve the bare minimum necessary without enacting comprehensive changes to the overall quality of resident care. For example, if they are aiming for another star in their rating and see that this would be achievable by having their physical therapist work for one more hour, they may do so and nothing else. Similarly, facilities appear to amend their practices specifically to dominate the Care Compare tool’s 5 star system. Still, audits are not regularly conducted on all facilities, and the industry is largely unpoliced on this self-reporting. Now, a data collection process based on payroll has been enacted to remove some of this gaming of the system. Previously, staffing was self-reported, and so a nursing home could claim to have more staff than they actually employed, or they could boost the number of minutes they claimed that staff spent with each resident. Recent changes have made this more difficult in certain areas, such as staffing. Many elements of the Care Compare tool are self-reported, and evidence suggests that some facilities inaccurately report data (or obfuscate certain information) to boost their overall rating on the service.

Nursing Homes Game the Medicare 5 Star Systemįurther research into the ways that the Care Compare database is used has revealed that it is possible for nursing homes to utilize the system to their own advantage-and not just in terms of increasing quality that leads to increased resident application. Further, savvy nursing home owners have learned tricks to game the CMS 5 star system, thereby masking a poorly performing nursing home as a 4 or 5 star facility. However, the data reflected in the Care Compare tool appears, upon further study, not to adequately reflect certain subsets of information. Studies have indicated that a modest change in the behavior of nursing homes occurred following the introduction of the Care Compare tool, as providers with low scores gradually lost market share and were incentivized to increase their appeal through higher ratings (and thus, better quality).

Later, in 2003, quality measures were added to multiple sections of the database, such as health inspection results and staffing data. After consistent issues with nursing home quality, the organization determined that the public did not have enough information to adequately compare different nursing homes when making a selection for their families. In 1998, the Centers for Medicare and Medicaid Services created the Nursing Home Compare database. The Data Behind Care Compare: What Is Missing? However, recent data suggests that Medicare’s 5 star care compare system is deeply flawed and misses many critical reporting areas. Medicare’s Care Compare tool allows users to compare local nursing homes utilizing Medicare’s 5 star nursing home rating system.

Medicare gov nursing home compare