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.
The ratings program, which is run by the U.S. Centers for Medicare & Medicaid Services, or C.M.S., relies on a mix of self-reported data from more than 15,000 nursing homes and on-site examinations by state health inspectors.
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.