Changes to CMS information website on nursing homes could lead to consumer confusion
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Anyone who has ever worked in an office setting with a communal refrigerator has – at some point – had food go missing at the hands of a hungry or mistaken colleague. Few would consider this some form of abuse that raises larger questions about the quality of the workplace.

Unfortunately, changes to an important source of information for nursing home residents and their families recently implemented by the Centers for Medicare and Medicaid Services (CMS) could cause minor incidents, such as missing food, to mislead consumers about the broader quality of care provided by a facility.

Keeping nursing home residents safe and healthy is the No. 1 priority of thousands of dedicated caregivers across the country. Even one case of abuse or neglect is one too many. An important aspect of abuse prevention is transparency.


Nursing home residents and their families should be empowered to make informed decisions on care. Nursing Home Compare, a website maintained by the federal government that provides information about skilled nursing centers, is a valuable tool in the effort to provide consumers with more information. Data on the site is obtained through Medicare and Medicaid claims, as well as annual inspections. The website uses this information to assign facilities an overall rating of one to five stars, as well as ratings for specific areas that include staffing, quality of care and regulatory compliance.

Beginning on Oct. 23, 2019, CMS made changes to this program so that reviews of facilities cited for one of three standards of abuse and neglect display an icon to warn consumers. The icon consists of a red stop sign with a hand on it. On its face this may seem like a straightforward method to convey information to the public. However, a closer examination reveals that rather than improving transparency, this new icon may lead to greater confusion and uncertainty.

A couple of real-world examples that would result in the new icon being displayed illustrate this point. One example involves missing food. A resident of a dementia care facility was storing guacamole in a communal refrigerator. It went missing. As this is classified as “misappropriation of property,” the facility is obligated to report this to the state authorities, and it could result in an abuse citation.

Another example involves two residents leaving their facility’s dining room at the same time in wheelchairs. They bumped into each other. Neither resident was injured, but this too resulted in an abuse citation.

Regardless of the overall quality of care at these two facilities, both could be subject to the new alert icon on the Nursing Home Compare website. Facilities that receive the new icon also have their five-star ratings capped at two stars, which will mask information from other important quality concerns that impact this rating. This is inconsistent with the stated goal of CMS to help “consumers develop a more complete understanding of a facility’s quality.” The symbol could lead people to avoid a facility altogether based on incomplete information.


There are better ways to increase transparency that would be less prone to mislead consumers. For instance, using an icon that indicates the need for closer examination – such as a yellow triangle with an exclamation point – instead of outright avoidance, would be more appropriate.

In addition, CMS should add customer satisfaction to Nursing Home Compare, because that is the best way for consumers to select facilities. While virtually all other health care sectors, such as hospitals, have a CMS reporting requirement on satisfaction, skilled nursing does not. Making this information available to future residents and their families will go a long way toward enhancing transparency.

Ultimately, the most surefire way of ensuring transparency is for those choosing a nursing center for themselves or a loved one to make visits to facilities in their area. There they can ask questions about the specific services provided, ask questions of staff, other families and residents, and learn about payment options.

As we work to increase transparency and eliminate any instances of abuse and neglect, it is vital that we do so in a way that makes information easier to understand for the people we serve. Misleading, ambiguous information is a step in the wrong direction.

Mark Parkinson is the president and CEO of American Health Care Association and National Center for Assisted Living.