New Investigation Uncovers Flaws in Nursing Home Rating Systems


An investigation found that nursing homes with five-star ratings often received citations for abuse and neglect.

A new investigation by the New York Times examines how nursing homes use the star rating system to “mislead the public.” As the article explains, the nursing home star rating system, in which one star is the lowest rating and five star is the highest ratings, has been “a popular way for consumers to educate themselves and for nursing homes to attract new customers.”

However, the report suggests, the system in fact offers “a distorted picture of the quality of care” at nursing homes, with many facilities manipulating the rating system to conceal failings that led to disproportionate nursing home resident deaths during the Covid-19 pandemic. The Times ultimately found that residents “at five-star facilities were roughly as likely to die of the disease as those at one-star homes.”

The rating system is operated by the Centers for Medicare and Medicaid Services, according to the Times, and is determined according to information self-reported by nursing homes and health inspectors who conduct in-person inspections. As the Times explains, the ultimate rating is “based on how they fare in those inspections; how much time nurses spend with residents; and the quality of care that residents receive.” In its investigation, the Times “built a database to analyze millions of payroll records to determine how much hands-on care nursing homes provide residents,” and examined state inspection records and financial statements. Its findings include the following:

The self-reported data is often wrong, with the incorrect data usually providing an inaccurately rosy picture of a nursing home’s cleanliness and safety; some facilities “inflate their staffing levels by, for example, including employees who are on vacation”; some facilities under-report the number of their residents on anti-psychotic medications; some facilities fail to report residents’ “accidents and health problems”; nursing homes with five-star quality of care ratings “are nearly as likely to flunk in-person inspections as to ace them,” but their self-reported data is not audited by the federal government; there are indications that “some nursing homes know in advance about what are supposed to be surprise inspections”; five-star facilities are often cited for abuse and neglect, but inspectors “rarely deemed the infractions serious enough to merit lower ratings.”

There are more than 3,500 nursing homes with five star ratings, according to the Times, which found that more than 2,400 of them had received citations for failures to comply with health code provisions regarding abuse or infection prevention and control. Many five star nursing homes had residents who “developed bed sores so severe that their bones were exposed,” or who lost motor function. Ultimately, one expert suggested to the Times, having spent years gaming the system instead of actually improving their quality, nursing homes were unprepared for the pandemic, with sub-par staffing levels and infection control protocols that left patients vulnerable to Covid-19.

The full New York Times investigation on nursing home rating system deficiencies is available here.

The attorneys at the Law Offices of Thomas L. Gallivan, PLLC work diligently to protect the rights of nursing home residents.  Please contact us to discuss in the event you have a potential case involving neglect or abuse.

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