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A broken system has tragic outcomes in nursing homes


Children and grandchildren of our elderly population place their trust in nursing homes and their staff to provide the highest quality of care. While word of mouth from family and friends can play a role in decision-making, a government-mandated star rating likely carries more weight.

Implemented 12 years ago, the number of stars a nursing home receives – on a scale from one to five – provided a visual depiction of the residence’s reputation. The purpose is to provide evidence through significant amounts of information to make the metrics more about hard data instead of the emotional element for family members looking for a safe place for their loved ones.

For children of the elderly, the star system served as a gateway to more data that helped shape their decision-making process. For nursing homes, the number of stars served as advertising fodder to promote their facilities and attract new customers.

Manipulating metrics

As with any type of rating system that combines data with self-reported information from nursing home management, it can be and was manipulated to raise ratings and hide deficiencies. A New York Times report found that the system was already broken even before COVID-19. As the virus spread, nursing homes were left woefully unprepared.

The once reliable “star system” was anything but. NYT’s study revealed that the chances of dying at a one-star or five-star facility were precisely the same. A great deal of inaccurate data includes:

  • Misinformation on the actual safety and cleanliness of the facility
  • Inflated staffing levels that include employees on vacation
  • Undercounting of patients on antipsychotic medication
  • Unreported accidents and health problems

And those five-star homes? Two thousand four hundred out of approximately 3,500 received citations for infection control problems and patient abuse.

Over 130,000 COVID deaths of nursing home residents have devastated families. Those tragedies are only compounded by the deception and manipulation that hid the problems. Shedding light on a dark situation may do little to ease the pain of these monumental losses, but it can provide families with a sense of justice.