On October 7, CMS announced changes to the 5-Star Quality Rating System on Nursing Home Compare. Most recently updated in April 2019, the latest changes address issues related to abuse in nursing homes and quality measures on pain.

Abuse

Beginning October 23, nursing homes that have been cited for abuse that either caused harm or had the potential to cause harm will be indicated on Nursing Home Compare with a special icon according to the criteria below.

Abuse was cited under the following tags:

• F600 Protect each resident from all types of abuse, such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
• F602 Protect each resident from the wrongful use of the resident’s belongings or money.
• F603 Protect each resident from separation from other residents, his/her room, or confinement to his/her room.
• F223 Protect each resident from all abuse, physical punishment, and involuntary separation from others.
• F224 Protect each resident from mistreatment, neglect, and misappropriation of personal property.

The above F-tags were cited as follows:

• Harm-level abuse citation: A facility received an abuse citation at G-level or higher on the most recent standard survey or on a complaint survey within the past 12 months.
• Repeated abuse citations: A facility received a citation of abuse at D-level or higher on the most recent standard survey or on a complaint survey in the past 12 months and on the previous (i.e. second most recent) standard survey or on a complaint survey in the prior 12 months (i.e. from 12-24 months ago).

Icons will be updated monthly and an icon will be removed only after a nursing home no longer meets the above criteria and it has been determined that the circumstances that led to the citation(s) have been adequately remedied.

Additionally, star ratings for nursing homes with this icon will be capped at 2 stars for the health inspection rating, resulting in a maximum overall star rating no higher than 4 stars.

These changes are made in accordance with the 5-point plan announced by CMS Administrator Seema Verma in a blog post on April 15 and are an effort to increase transparency by helping consumers to identify nursing homes with instances of noncompliance related to abuse. LeadingAge President and CEO Katie Smith Sloan issued this statement on the transparency initiatives: “Abuse and neglect must never be tolerated, in any setting. Our members support efforts to help consumers make the best choice possible when choosing nursing home care for their loved ones.

The abuse icon in Nursing Home Compare, however well-intentioned, risks misleading consumers. It is built on the back of a flawed survey system, in which interpretations of regulations are notoriously inconsistent.

We need to fix the survey system before we start adding this warning sign. We want consistent application of regulations. We envision a system that allows flexibility to target resources where they are needed. LeadingAge members seek to work with surveyors, focusing less on punishment and more on consultation, training and continuous improvement.

We all want the best quality care and quality of life for our loved ones.”  

Nursing Home Compare will also display a disclaimer for all Oregon nursing homes according to recommendations by the Government Accountability Office in its April 2019 report. This disclaimer will alert consumers that incidents of abuse may not be reflected on the Nursing Home Compare website and will refer them to Oregon’s Adult Protective Services website.

Quality Measures

CMS announced that 2 quality measures will be removed from Nursing Home Compare. The short-stay and long-stay measures for residents who report moderate to severe pain will be removed from Nursing Home Compare and the 5-Star Quality Rating System. Accordingly, cut-points for short-stay, long-stay, and overall quality measure ratings will be adjusted beginning October 2019.

For more information on these changes, refer to the Quality, Safety & Oversight Group memo QSO-20-01-NH and the updated 5-Star Quality Rating System Technical User Guide. LeadingAge will monitor the impact of these changes and will share any additional information or updates as available.