Nursing Homes That Flunk the Care Test

Nursing homes that want Medicare or Medicaid funds must submit to state inspections to see whether residents covered by those programs are receiving decent, safe care. The federal Centers for Medicare and Medicaid Services posts the results of the inspections online as part of its Nursing Home Compare tool, and the results, unsurprisingly, show that such care is by no means universal. But a handful of homes out of the roughly 16,000 operating in this country do badly over and over in these inspections; CMS calls them special-focus facilities, and they are inspected more frequently and watched more closely. As of last month there were 128 such nursing homes.

Today CMS released a list of the 54 worst offenders, facilities seemingly unable to improve after many months—some of them after several years. Perhaps shining a light on them, CMS reasoned, might push these homes to change.

The thought that someone precious to you might be in one of the 54 is chilling. A look at the inspection performance of five of the homes on the list, chosen more or less at random across different parts of the country, did turn up one seriously frightening report: a home in Arkansas that in five different areas put residents in "immediate jeopardy" of their health or safety. Among them were failure to protect residents from "mistreatment, neglect, and/or theft of personal property," to keep the facilities free of hazards that could cause accidents, and to meet standards for installing, maintaining, and testing the fire alarm system.

The reports on the four other homes, on the other hand, suggested to me that if a home of interest to you is on the list, checking out its inspection report online by going to the Nursing Home Compare page might take the edge off your concern (as well as raising tough questions to pose to the administrator). The number of violations may be disconcertingly high, but only a tiny number rose to the "immediate jeopardy" level. Most were in the category of "potential for minimal harm" or "minimal harm or potential for actual harm." That doesn't make them excusable, but at least the lives of the residents of these nursing homes don't seem to be in real danger.

That CMS is pushing these bad actors into the spotlight is commendable. I'm still waiting, however, to see real data on such characteristics as infections, falls, and bedsores, not approximations and descriptions. Only painting by the numbers will give us a true picture. That day, CMS has assured me, is coming.