Failing the Frail

October 26, 2016

Based on measures used by nursing home experts, Forest Park Health Center – a triangular complex of red brick walls and manicured lawns in Carlisle – was understaffed in 2014.

According to Nursing Home Compare, the pre-eminent, government-run website for picking nursing homes, the facility's registered nurses only provided an average of 31 minutes of care per day to its residents. That's well below the minimum 45 minutes recommended by researchers, greatly increasing the risk of neglect and care-related mistakes.

But like thousands of other nursing homes across the country, that level of understaffing was worse than it looked. According to a PennLive national analysis of Medicare and Medicaid reimbursement data, Forest Park provided an average of only 16 minutes of care each day that year – a level experts consider dangerously low.

Guardian Elder Care, the owner of Forest Park Health Center, disputes PennLive's findings and argues that its homes provide appropriate care. Experts disagree. Hours of care, they say, particularly from registered nurses at recommended levels, is one of the most important determinants of a home's quality.

But PennLive found that families rarely have access to accurate data about staffing. Of the 11,000 nursing homes included in its analysis, nearly half had registered nurse levels on Nursing Home Compare that were 50 percent higher than their federal reimbursement reports.

READ MORE: This is part four in a series. Read part one, part two, part three, part five and part six.

Pennsylvania fared somewhat better than the national average: 37 percent of its homes over-reported by 50 percent or more.

In Louisiana, by contrast, the rate was 95 percent – the worst in the nation.

Source: PennLive analysis of Centers for Medicare and Medicaid Services data.

The federal government has been aware of the inaccuracy of data used on Nursing Home Compare since at least 2000 and multiple studies, most notably a 2007 paper by researchers at Texas A&M University and a 2014 report by the Center for Public Integrity, have found similar discrepancies. PennLive modeled its analysis on those studies using more recent national data.

PennLive found that despite increased scrutiny, and some efforts by the federal government to tamp down on over-reporting, Nursing Home Compare still provides often wildly inaccurate staffing information to the public.

While the federal government is working to update the website with more accurate, payroll-based data, it's still unclear when that will happen. The Centers for Medicare and Medicaid Services is now four years past a deadline in the Affordable Care Act to do that.

"Your findings show that this system should have been up at least a decade ago and it can't be up and functioning fast enough," said Robyn Grant, public policy and advocacy director for National Consumer Voice for Quality Long-Term Care. "We are truly worried that the public are making decisions based on information that is just chronically flawed."

A national problem

The staffing hours that appear for Forest Park on Nursing Home Compare, like all nursing homes under the current system, were self-reported.

When nursing homes are inspected annually they are required to provide a two-week snapshot of their staffing level to inspectors. Because the numbers they provide are rarely audited, researchers and senior care advocates have long suspected that nursing homes inflate them.

Reporting higher staffing levels not only can make a home look better under Nursing Home Compare's "staffing" page, but they have a big impact on its overall star rating. Well-staffed homes are more likely to get the website's coveted "five star" rating.  (Click to Continue)

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Failing the Frail