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Secretive Appeals Process Allows Worst Nursing Home Offenses to be Kept From the Public

Secretive Appeals Process Allows Worst Nursing Home Offenses to be Kept From the Public

Many seeking a nursing home for their loved ones rely on the one to five-star rating system offered by the Centers for Medicare and Medicaid Services (CMS). Five is the highest rating, while one is the lowest.

According to a New York Times investigation, the ratings are not necessarily accurate because incidents reported by state inspectors are not being reported by the federal government or included in the rating system.

For instance, the following situations were reported by state investigators at dangerous facilities but not factored into the nursing home’s CMMS rating:

  • Arizona nursing home resident sexually abused in the facility dining room.
  • Texas resident with dementia found in the nursing home parking lot lying a pool of blood.
  • Minnesota resident caught COVID-19 after workers placed a sick resident in her room.

Secretive Appeals Process

Most violations reported by an inspector are minor and easily remedied. However, if a nursing home receives a severe citation from an inspector involving situations where actual harm occurred, or residents are in immediate jeopardy, they can fight the citation via a secret appeals process.

It starts with an informal review of the citation. Should the nursing home receive an unfavorable outcome, they can appeal to a special federal court inside the executive branch.

All of these machinations are hidden from the public. In fact, affected residents and their families cannot participate in the appeals process.

No matter the eventual outcome, the appeals process takes a lot of time. The longer the delay, the less likely the public will ever know about the nursing homes’ problems.

If the nursing home wins the appeal, the citation severity is lowered or erased entirely. Recently, nursing homes that failed to isolate COVID-19 patients won appeals and can state that health deficiencies were not found.

The Wrong Data

According to the investigation, much of the data submitted to the CMS is wrong. That inaccurate data virtually always makes nursing homes appear better than they are actually are in terms of safety and hygiene.

Because government audits are rare, nursing homes can get away with filing misleading reports. As an example, nursing homes that self-report as meeting five-star criteria often fail in-person inspections.

Other issues include staff level inflation in a notoriously short-staffed industry. Nursing homes may include staff who are on vacation at any given time as part of active personnel.

Health problems among residents and accidents are not reported, and there is extreme underreporting about the number of residents receiving antipsychotic medications.

There is also evidence that some nursing homes are tipped off about impending inspections, so inspectors are not witnessing how the facility normally runs.

Stars and Profits

The rating system has a considerable effect on nursing home profits. Roughly 70 percent of all U.S. nursing homes are for-profit entities, and those rated with four or five stars bring in much more revenue than those with only one or two stars.

Nothing affects a rating like a severe violation. Some states discourage inspectors from issuing severe citations. In at least 40 nursing homes with a five-star rating, inspectors decided sexual abuse did not constitute actual harm or that residents were in immediate jeopardy.

Learn more on our nursing home abuse and neglect page. Do you have a case against a nursing home facility? Contact us online, at [hidden email], or at 833.201.1555. We work on a contingency basis - charging nothing unless we win your case.

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Related topics: nursing home abuse (52) | nursing home neglect (60)


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