GOVERNMENT STUDY REVEALS SERIOUS LIMITATIONS
IN NURSING HOME COMPARE DATA

An attorney defending a nursing home accused of negligence may consult the Nursing Home Compare web site, (http://www.medicare.gov/Nhcompare/Home.asp), for background information on various quality of care parameters for that facility as compared to its peers. Nursing Home Compare is maintained by the United States Department of Health and Human Services and provides a searchable database of federal standard compliance among institutions caring for Medicare and Medicaid beneficiaries. This resource contains data on various characteristics of a given nursing home and its resident population, as well as findings from annual inspections by state regulatory authorities as compiled by the Center for Medicare and Medicaid Services (CMS).

At the request of U.S. Representative Henry A. Waxman and Senator Charles E. Grassley, the Special Investigations Division of the Committee on Government Reform evaluated the accuracy of information presented by Nursing Home Compare. Findings suggest that deficiencies in information published by this web site could potentially seriously misinform an attorney who formulates a line of defense based upon statistics promulgated by this site.

Although Nursing Home Compare summarizes information on those violations identified during annual state nursing home inspections, it fails to accurately report other violations resulting from complaint investigations conducted by state authorities. Researchers noted that across the study sample period, October 1, 2000 to December 31, 2001, complaint investigations uncovered 25,204 documented violations of federal standards in nursing homes. None of these violations was incorporated into the Nursing Home Compare database.

Violations of greatest importance, those posing life-threatening, immediate jeopardy to nursing home residents, were found to be under-reported by some 1,138 cases. In one extreme instance, investigators noted that a patient had expired in a "river of blood" when a graft site aneurysm in his arm ruptured. As this crisis unfolded, nurses failed to institute appropriate measures to quell the bleeding. Because of these types of omissions, a visitor to the Nursing Home Compare web site might assume that a given nursing home offers safe and effective nursing care, when in reality it might be seriously out of compliance with federal regulations.

During the fifteen-month study, 871 U.S. nursing homes were cited by state inspectors for immediate jeopardy violations that caused or could potentially result in death or serious injury to facility residents. Nursing Home Compare fell short of documenting these violations for 471 institutions. In one case, investigators discovered that poor nursing home monitoring of a resident allowed him to wander away from the facility for thirteen hours on a twenty-six degree February night. The resident later required hospitalization for exposure-related injuries.

Although somewhat less serious than immediate jeopardy violations, actual harm type of violations are also a concern to state nursing home inspectors. Within the sample time period, nursing homes received 4,406 citations as an outcome of investigations into actual harm complaints. Although Nursing Home Compare published information on 6,437 actual harm violations noted during annual state inspections, the website under-reported the true nature of actual harm violations by 41% because of omitted complaint data. For 1,346 nursing homes with acknowledged violations, Nursing Home Compare contained no record of this information.

A statistical analysis of actual harm and immediate jeopardy violations documented by this report illustrates the significance of these oversights. Some 1,136 violations resulted from lack of accident prevention among residents. Complaints of resident abuse produced 711 violation reports. Failure to avert pressure ulcers or to provide adequate treatment of existing skin breakdown resulted in 580 violations. Dehydration or inadequate resident nutrition led to 268 citations. None of this information was entered into the Nursing Home Compare database.

The report of the Special Investigations Division was released on February 21, 2002, and can now be accessed via the following link. Representative Waxman and Senator Grassley discussed this report's findings in a letter to Thomas Scully, Administrator at CMS. They urged that the Nursing Home Compare database be reformed within thirty days following release of this report, to include the missing violation information. The Waxman/Grassley correspondence can be viewed at the following link.

Through its Nursing Home Quality Initiative project currently piloted in six states, CMS is seeking to enhance the information contained in Nursing Home Compare. Data derived from Minimum Data Set (MDS) assessments will be organized in this program according to seven risk-adjusted quality measures for long-term care residents and three measures for post-acute care residents. A mid-April rollout date was projected for this pilot study's data. Further details about the Nursing Home Quality Initiative and more detailed descriptions of the quality measures included in this project are available at http://cms.hhs.gov/providers/nursinghomes/nhi/.

Reviewed by: Elizabeth B. Juliano and James R. Fell

* Special Investigations Division, Committee on Government Reform, U.S. House of Representatives. HHS 'Nursing Home Compare' Website has Major Flaws. February 21, 2002.

Return back to articles page.