November 21, 2019

CMS on its Nursing Home Compare website has begun indicating when nursing homes have been cited for abuse violations, and while the move has been applauded by consumer advocates, some in the nursing home industry say the alerts are misleading.

Infographic: What do consumers want from post-acute care?

CMS adds alerts to Nursing Home Compare

CMS' Nursing Home Compare website assigns a certain number of stars to nursing home facilities, similar to systems used to rate hotels. The best possible rating Medicare can give to a nursing home is five stars. The ratings are designed for both consumers and providers, who use them to help decide where to refer patients when they are discharged from hospitals.

CMS last month announced that it would add a new icon—which is a red circle with a white stop hand in the center—to the site to alert consumers when a nursing home has been cited for incidents of abuse, neglect, or exploitation. CMS said the consumer alert icon would appear next to facilities that have been cited in inspection reports for abuse that caused a resident harm within the past year, as well as abuse that could have potentially caused residents harm in the past two years.

CMS added the icons to the site late last month, and they appear directly next to the names of facilities that have received citations. According to the data-analysis company StarPRO, CMS has affixed the icon to ratings for 760, or roughly 5%, of the 15,262 facilities on the site. Entries with the icon also feature detailed inspection reports that were conducted after complaints of abuse, neglect, or exploitation were made.

CMS said it will use the agency's latest inspection data to update the icons each month, and it will remove the consumer alert icon when nursing homes have fixed the issues that caused the citations. According to the Wall Street Journal, CMS will remove the icon once a flagged facility goes without an abuse citation for one year.

Icon draws mixed reaction

Consumer advocates praised the icon's introduction, but said the tool is imperfect and is based on an inspection system that often misses cases of abuse.

Richard Mollot, executive director at the Long Term Care Community Coalition, said, "We just hit the tip of the iceberg here. We are not finding the harm that's out there. If we see a few occasions that are getting out, I think it's an important alert for the public."

However, some in the nursing home industry have said the icon is misleading and could unfairly damage a facility's reputation. In addition, others in the industry have argued that states' inspection standards are inconsistent and definitions of "abuse" are too loose.

Mark Parkinson, CEO of the American Health Care Association, said the new icon could create "unnecessary worry and concern among residents and their families and decrease access to care."

Katie Smith Sloan, CEO of LeadingAge, said, "This icon, which does nothing more than shout, 'Stop! Do not proceed!' simply isn't up to that job" (Hayashi, Wall Street Journal, 11/19; Owens, "Vitals," Axios, 11/20).

What do consumers want from post-acute care?

Patient choice is critical in post-acute and long-term care. To learn what patients and their families want when making that choice, we conducted a national consumer survey measuring preferences on everything from care delivery to decor. Four major lessons stood out.

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