Why COVID-19 deaths were reportedly nearly as likely in 5-star nursing homes as 1-star facilities

During the coronavirus pandemic, people living at five-star long-term care facilities in the United States have been roughly as likely to die from a COVID-19 infection as those at one-star nursing homes, a New York Times investigation found. While the virus presents a high risk to older people regardless of their living situation, the Times investigation also revealed that the federal government's nursing home rating system is deeply flawed and susceptible to manipulation, perhaps helping pave the way for the national crisis-within-a-crisis that took route early on in the pandemic.

To evaluate the ratings' reliability, the Times built a database that analyzed "millions of payroll records to determine how much hands-on care nursing homes provided, combed through 373,000 reports by state inspectors, and examined financial statements submitted to the government by more than 10,000 nursing home." Additionally, the paper got access to ratings data that weren't publicly available from academics "who had researched agreements with the Centers for Medicare & Medicaid Services."

The Times concluded that homes often pass the government incorrect information that makes them seem cleaner and safer than they are. They'll reportedly inflate staffing levels by including employees who are on vacation, understate the number of patients on dangerous antipsychotic medications, and leave accidents and health problems unreported. Per the Times, nursing homes that earned five stars for their self-reported data were nearly as likely to fail their in-person inspections as they were to "ace them," but the government reportedly rarely audits the nursing homes' data.

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All told, it created a situation in which nursing homes "were working to improve their ratings, but not their quality," Charlene Harrington, who sits on a board that advises C.M.S. told the Times, noting that they were therefore unprepared for the pandemic — with a pass from the government. Read more at The New York Times.