When five-star care is substandard

This editorial is from the New York Times:

Medicare has devised a rating system for nursing homes that portrays many of them as much better than they really are. Consumers should be aware that a top five-star rating from Medicare, achieved by a fifth of the more than 15,000 nursing homes nationwide, may mask serious and potentially dangerous deficiencies.

The rating system, described a New York Times article published in Monday’s Press Democrat, has major flaws, including an overreliance on self-reporting by the nursing homes and failure to include negative information gathered by states. The ratings are based on three criteria. Two of the three - staff levels and quality statistics - are reported by the nursing homes and accepted at face value by Medicare without verification.

Only the other criterion - the results of annual health inspections - relies on independent assessments by state inspectors. In addition, the ratings do not take into account other potentially damning information gathered by state authorities.

Consider, for example, Rosewood Post-Acute Rehab, a 110-bed nursing home in Carmichael, a suburb of Sacramento. It has a fancy lobby and a five-star rating from Medicare - despite the fact that last year California fined Rosewood $100,000, the highest penalty possible, for causing the death of a woman in 2006, who overdosed with a powerful blood thinner. From 2009-13, the state received 102 consumer complaints and reports of problems at Rosewood. An advocacy group says the total was actually 164, twice the state average.

Rosewood has also been subjected to about a dozen lawsuits in recent years from patients and their families alleging substandard care. One woman’s suit contends that Rosewood failed to treat her mother for a respiratory condition that led to her death. She had put her mother there because of its five-star rating. Another family attracted by the top rating is suing Rosewood because a parent died after experiencing serious falls there. Current and former patients, their families and former employees told the Times that there is often a shortage of quality staff and a scarcity of basic supplies like washcloths. Patients often live three to a room.

A 2010 death at another nursing home in the same chain, which was rated at four stars at the time and five stars now, was attributed by a coroner in part to bedsores that had developed gangrene and were infested with maggots, and in part to a urinary tract infection. The failures and mishaps described at Rosewood and other nursing homes are of a kind that could almost always be prevented by vigilant care delivered by a sufficient number of well-trained staff.

Officials at the Centers for Medicare and Medicaid Services, which runs Medicare, say the rating system is supposed to give nursing homes an incentive to improve, but many nursing homes have found ways to game the system. They often know when inspectors will show up and add workers just beforehand and sharply cut staff immediately afterward. And the quality data compiled by the nursing homes themselves - such as how many patients develop bedsores or experience serious falls - is obviously subject to manipulation.

The Affordable Care Act requires Medicare to use payroll data to verify staff levels, but the agency is still working on such a verification system. Medicare should also spot-check the quality statistics while developing a broader auditing program. Improvements are clearly necessary - and soon, because Medicare is about to introduce similar five-star ratings for hospitals, dialysis centers and home-health-care agencies.