Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public

Nursing homes have manipulated the influential star system in ways that have masked deep problems — and left them unprepared for Covid-19.

 

Carrie Johnson was recuperating at Brookdale Richmond Place in Lexington, Ky., after spinal fusion surgery. An untreated infection left her unable to walk or even stand. Credit...Jessica Ebelhar for The New York Times

By Jessica Silver-Greenberg and Robert Gebeloff

 

Twelve years ago, the U.S. government introduced a powerful new tool to help people make a wrenching decision: which nursing home to choose for loved ones at their most vulnerable. Using a simple star rating — one being the worst, five the best — the system promised to distill reams of information and transform an emotional process into one based on objective, government-blessed metrics.

The star system quickly became ubiquitous, a popular way for consumers to educate themselves and for nursing homes to attract new customers. During the coronavirus pandemic, with many locked-down homes unavailable for prospective residents or their families to see firsthand, the ratings seemed indispensable.

But a New York Times investigation, based on the most comprehensive analysis of the data that powers the ratings program, found that it is broken.

Despite years of warnings, the system provided a badly distorted picture of the quality of care at the nation’s nursing homes. Many relied on sleight-of-hand maneuvers to improve their ratings and hide shortcomings that contributed to the damage when the pandemic struck.

More than 130,000 nursing-home residents have died of Covid-19, and The Times’s analysis found that people at five-star facilities were roughly as likely to die of the disease as those at one-star homes.

The ratings program, run by the U.S. Centers for Medicare & Medicaid Services, relies on a mix of self-reported data from more than 15,000 nursing homes and on-site examinations by state health inspectors. Nursing homes receive scores based on how they fare in those inspections; how much time nurses spend with residents; and the quality of care that residents receive. Those three grades are then combined into an overarching star rating for each nursing home.

To evaluate the ratings’ reliability, The Times built a database to analyze millions of payroll records to determine how much hands-on care nursing homes provide residents, combed through 373,000 reports by state inspectors and examined financial statements submitted to the government by more than 10,000 nursing homes.

The Times obtained access to portions of the ratings data that aren’t publicly available from academics who had research agreements with the Centers for Medicare & Medicaid Services, or C.M.S.  (Click to Continue Reading)

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Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public