Report Cards are Out

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

May 29, 2019 saw the latest refresh of Nursing Home Compare (NHC) – the first report card of the spring. This past week saw additional report cards being published by various sources.  They are each important in their own way.  Take a look:

Families’ and Residents’ Right to Know: Uncovering Poor Care in America’s Nursing Homes was released by U.S. Senators Bob Casey (D-PA) and Pat Toomey (R-PA).  “Through the release of the (April 2019) SFF candidate list and this report, which details preliminary findings from surveys and public information about these candidate facilities, the Senators aim to provide Americans and their families with the transparency and information they deserve when choosing a home in which to entrust the care of a loved one.  The SFF program is designed to increase oversight of facilities that persistently underperform in required inspections conducted by state survey agencies.  As stipulated by federal law, the SFF program targets those facilities that “substantially fail” to meet the required care standards and resident protections afforded by the Medicare and Medicaid programs.”  This 26-page report is the first of likely several SFF reports to be made public – to consumers.  Senators Casey and Toomey feel strongly that performance information for these SFF facilities should be available to the consumers of long-term care: residents and families.  With the April 2019 NHC refresh, CMS opted to suppress star ratings for participants in the Special Focus Facility (SFF) program, namely to “reduce confusion and help consumers understand the current status of each facility’s quality.”  Nursing homes that are participants in the SFF program are designated online with a small yellow triangle that resembles a “caution” traffic sign. An individual visiting Nursing Home Compare can hover a cursor over this triangle for a short description of the SFF program and information explaining why the nursing home has no stars displayed.

Their report notes this on page 3: Participants of and candidates for the SFF program represent only a small fraction of facilities. Of the more than 15,700 nursing homes nationwide, less than 0.6% (a maximum of 88 facilities) are selected for the program. The names of these facilities are made public. An additional 2.5% of facilities (approximately 400 facilities) qualify for the program because they are identified as having a “persistent record of poor care” but are not selected for participation as a result of limited resources at the Centers for Medicare and Medicaid Services (CMS).  Despite being indistinguishable from participants in terms of their qualifications for enhanced oversight, candidates are not publicly disclosed. As a result, individuals and families making decisions about nursing home care for themselves or for a loved one are unlikely to be aware of these candidates.

Families for Better Care, a Texas-based nursing home resident advocacy group, published its third state- by-state report card yesterday.  On that landing page, you are initially presented with a map of the U.S.


You can click on any state or select the state from the drop-down beneath the map.  When you select the Overall State Grades drop-down, you have several options available to look at, as shown above.

You’ll also want to review the summary or overview of this group’s findings this year which is found at:  This year’s report speaks to staffing levels:

  • The majority of nursing homes (54 percent) were incapable of scoring an above average staffing rating.
  • Residents received just 2 hours and 33 minutes of direct care daily—an average that’s unchanged from the previous report card.
  • Nearly every state—with the exception of Alaska, the District of Columbia, and New Mexico—suffered a net loss in the percentage of nursing homes with above average staffing levels over the past three report cards.

Brian Lee, Families for Better Care’s Executive Director, says this about the findings: “The best way to heal America’s nursing homes is to appropriate additional funding to be used solely for hiring more staff. No more excuses, no more threats, no more scare tactics from lobbyists, politicians, operators—or anyone else for that matter—it’s time to do what’s right and stop the infliction of our loved ones with unnecessary injury or harm because of negligent policy making.”

Another report card of sorts worth a read is the GAO (Government Accounting Office) report this week on addressing elder abuse, including neglect and exploitation.  The 49-page ELDER JUSTICE: Goals and Outcome Measures Would Provide DOJ with Clear Direction and a Means to Assess Its Efforts report is a very interesting read as well.

The GAO made these 2 recommendations to Attorney General William Barr and the Department of Justice:

  • The Attorney General should develop and document goals that explain the common outcomes DOJ seeks to achieve through its elder justice efforts.
  • The Attorney General should develop and document outcome measures to track the progress the agency is making toward achieving its elder justice goals.

The report has these conclusions:

“Researchers estimate that as many as 1 in 10 older adults in the United States—age 60 or older—experience abuse, although elder abuse is generally underreported. DOJ has undertaken several new efforts in response to EAPPA and on its own accord to address this issue, but has not developed or documented goals and outcome measures to guide and assess its elder justice efforts. Developing and documenting goals that explain the common outcomes of its elder justice efforts and outcome measures that track its progress against elder justice goals would provide DOJ with clear direction for its efforts and a better means to assess the results of its elder justice efforts.”

I encourage you to review these report cards as they take the temperature of the LTC industry and its regulators at this point in time.