CMS Adds New Abuse Icon to Help Consumers Identify Nursing Homes Cited for Abuse

Posted On December 30, 2019 In the News,Medicare/Medicaid,Nursing Home Abuse

In October 2019, the Centers for Medicare and Medicaid Services (or “CMS”) began using a new abuse icon on the nursing home compare website. The icon looks like this

and is called a “consumer alert icon.” The consumer alert icon is placed next to the name of any facility that has received a citation for abuse that led to the harm of a resident within the past year or a facility that was cited for abuse that could have potentially led to resident harm in each of the previous two years. CMS defines abuse as the “willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.” (42 C.F.R. Section 483.5.)

What Is the Nursing Compare Website?

The nursing home compare website can be a useful tool in searching for the right nursing home for a loved one. The nursing home compare website is published by CMS and contains information about every nursing home (or skilled nursing facility) in the country receiving state or federal government funds. Currently, there are over 15,000 nursing facilities listed on the website. You can find the nursing home compare website here: https://www.medicare.gov/nursinghomecompare/search.html?

A consumer can review anything from facility staffing levels to the facility’s deficiency history to the owners of the nursing home on the website, among many other things. It can be overwhelming with the amount of information available to a consumer, but it still provides valuable insight for anyone trying to find a quality nursing home for a loved one. The nursing home compare website provides a quality rating system that is known as the “5 Star Quality Rating System.” Scores range from zero stars (the worst) to five stars (the best). The star rating system includes three categories that each receive their own star rating and are combined into an overall rating. The three categories are (1) health inspections; (2) staffing; and (3) quality measures.

CMS is trying to make it quicker and easier for anyone investigating a potential nursing home to find out if it has a history of serious deficiencies. CMS plans to update the nursing home compare website on a monthly basis to add the consumer alert icon to facilities receiving citations for abuse. Once facilities receive a citation for abuse, they must submit a Plan of Correction detailing what the facility plans to do to correct the citation. CMS must then approve the Plan of Correction. You, as a consumer, can also review the Plans of Correction when they are uploaded to the nursing home compare website.

Reactions to the Consumer Alert Icon

Some representatives of the nursing home industry have criticized the consumer alert icon. They feel the icon sends too strong of a signal to the consumer because the icon suggests the consumer should stop before going further as opposed to proceeding cautiously. One suggested change by the nursing home industry is a yellow triangle with an exclamation point inside indicating a consumer should be cautious. Another criticism is that the icon stays on the nursing home compare website for one year from the date of the abuse citation no matter what the facility does to correct it and whether the abuse citation is the only citation the facility received. Any facility with the abuse icon will have its star rating for health inspections limited to a maximum of two stars and its overall star rating will be limited to a maximum of four stars. Nursing home representatives have criticized this as too harsh a punishment for what might be the only infraction by a facility.

In reality, the new abuse icon is helpful to consumers. Only the most serious cases of abuse will receive a citation and consumers have a right to know whether a nursing home has a history of abuse. Even one incident of abuse is too many. It is expected that fewer than five percent of the over 15,000 skilled nursing facilities will receive an abuse icon. This is a small number of facilities considering how serious an abuse citation is.

The consumer alert icon is a small part of a dramatic change in the regulations applicable to nursing homes. These changes took effect in phases starting in November 2016. There were three phases with the last one taking effect November 28, 2019. The overall purpose of the new regulations was to improve resident care, to provide consumers a more transparent view of nursing homes, and to make sure consumers have access to reliable information. While the new system isn’t perfect, it’s certainly an improvement. In the past, some of the data published on the nursing home compare website, like staffing information, was self-reported by the facilities. CMS did not check the accuracy of the data, which caused misleading and sometimes exaggerated staffing numbers to be posted on CMS website.

Closing Thoughts

Whether a facility has a consumer alert icon or what the facility’s star rating is should not be the end of your investigation. There are many other factors that should go into deciding whether to place a loved one in a nursing home like visiting the facility at random times, noticing any unusual sounds or smells, distance from your home, your feeling of comfort when visiting, etc. However, the icon and related star ratings are helpful in making the difficult decision to place a loved one in a nursing home. If your elderly loved one is already living at a facility and you suspect abuse, report the abuse and then speak with a compassionate Orange County nursing home abuse attorney.