Report shows many nursing home
violations not have been publicly reported

nursing home

Photo by Ulrich Joho via Flickr (CC BY-SA 2.0)

As many as 10,000 nursing homes may have deficiencies unreported or may have been inaccurately described by the Centers for Medicare and Medicaid Services to Care Compare, according to an April 2023 report by the U.S. Department of Health and Human Services Office of Inspector General (OIG). 

The report is based on a random sampling of 100 of the 15,377 nursing homes by OIG, which compared the deficiencies reported on Care Compare as of December 10, 2020, with the deficiencies documented by state inspectors from the three most recent annual health, fire safety and emergency preparedness inspections and the three most recent years of complaint inspections.

Among those 100 facilities, OIG found that 67 had one or more unreported deficiencies. The specific facilities sampled are not named in this report. Journalists wishing to delve deeper into this issue will need to reach out to CMS directly.

OIG specifically estimated that Care Compare did not accurately reflect:

  • 5,228 nursing homes with health deficiencies,
  • 7,996 nursing homes with fire safety deficiencies, and
  • 308 nursing homes with emergency preparedness deficiencies.

Additionally, CMS did not report the results of all yearly fire safety and emergency preparedness inspections for 6,458 nursing homes on Care Compare.

According to OIG, Nursing homes are required to undergo yearly inspections for compliance with federal requirements that address such areas as resident rights (e.g., involvement in care planning, refusal of transfer and receiving visitors) staff training, infection control, and quality of care. When an instance of noncompliance is identified, a surveyor can cite a nursing home for any of nearly 400 health deficiencies. Nursing homes must meet Life Safety Code standards set by CMS based on criteria from the National Fire Protection Association, must have an emergency preparedness program which accounts for both natural and man-made disasters, and must coordinate with Federal, State, Tribal, regional, and local emergency preparedness systems.

Inspectors also follow up on resident, staff or family complaints between annual inspections. 

Families use CMS’ Care Compare to evaluate nursing homes based on benchmarks like staffing, number of beds, inspection reports, ownership, and number of COVID-19 vaccinations among residents and staff. The five-star rating system (with five being highest quality) allows for quick comparisons between facilities based on aggregated information as well as specifics for health inspections, staffing and quality-of-care measures. The results of a nursing home’s fire safety and emergency preparedness inspections are combined and reported together.

The Inspector General’s findings showed that “CMS’s processes for reviewing inspection results before and after they were reported on Care Compare were not adequate to ensure that deficiencies identified by surveyors during inspections were accurately reported on the website.” 

The OIG recommended that CMS immediately take steps to revise the Care Compare data to ensure accuracy, update the existing reporting software to further ensure accuracy, and strengthen agency processes for reviewing inspection results, including manual quality assurance verifications.

While inspection reports are only part of the data compiled for star ratings, the OIG concluded “the findings in this report demonstrate the need for CMS to take additional measures to ensure that the information it reports on Care Compare for nursing homes is accurate.”


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