The Centers for Medicare and Medicaid Services (CMS) is the federal agency that administers the Medicare and Medicaid programs. Medicare and Medicaid are the primary payers for care in skilled nursing facilities, commonly known as nursing homes.
Twelve years ago, CMS began rating nursing homes using a five-star scoring method. If a nursing home receives a one-star rating, the nursing home has poor quality measures. If a nursing home receives a five-star rating, the nursing home meets the highest rated quality measures. Each nursing home is rated in the areas of health inspections, staffing, and quality of resident care.
Since CMS began its rating service, I have told clients to review the rating that the nursing home received from CMS and to visit the nursing home in person to see if it measure up to that rating. I advise clients to simply show up at the nursing home without scheduling an appointment. Significant tells that I have found with nursing homes are the way the facility smells (clean or of urine and feces) and whether the residents are congregated in one area sitting in their wheelchairs with far away looks on their faces or is the nursing home staff engaging with the residents.
I have never believed that CMS’s rating system is the be-all and end-all to judging a nursing home’s quality. A recent article in the New York Times confirms this belief. The general upshot of the Times’s article is that much of the information CMS receives to rate a given nursing home comes from self-reported information from the nursing home. Obviously, the nursing home has no incentive to rate themselves poorly.
In my opinion, nursing homes perform a job that is very difficult. It is very difficult to profitably take care of aged and disabled individuals. Aged and disabled individual need a tremendous amount of care and their health is not good. They fall frequently, and when they fall, they tend to break parts of their anatomy.
Most nursing homes are privately operated, so the facility is in business to make money. But nobody forces the operator of a nursing home to go into the business of running a nursing home. And once these individuals voluntarily agree to take on the job of caring for fragile individuals, in my opinion, they are assuming a fiduciary duty—a duty of utmost care.
I have been practicing elder law for over twenty years, and in my opinion, in the past five years, if anything, the care provided by nursing homes has gone down, not up. And nursing homes are trying harder than ever to protect themselves by controlling all aspects of the resident’s life.
For instance, instead of recommending a family to an attorney experienced with elder law, nursing homes aggressively refer families to non-attorney Medicaid advisors. These non-attorney Medicaid advisors are supposed to represent the resident in applying for Medicaid benefits, but a large part of what these advisors do is report directly to the nursing home every aspect of the resident’s life, which they learn from the reams of information they receive from the resident in the application process. The advisors also prevent residents from receiving the advice of an attorney on issues surrounding the Medicaid application and other issues that may arise—for instance, I have referred several clients to personal injury attorney for injuries the client received in the nursing home and many of those clients have received substantial cash awards.
Recently, a client of mine told me the nursing home in which her parent resides repeatedly told her that they could apply for Medicaid for her parent. The child refused the facility’s “help.” Now, every day, the nursing home asks the child how the father will pay his bill—despite the fact that no bill has even issued at this time. The facility had the staff physician call the client’s child. Thinking something was wrong with her parent, the child returned the physician’s call, only to be harassed by the physician for payment.
You can’t make this stuff up, and you shouldn’t be without legal advice. Facilities are getting worse, not better. Don’t be caught up in their world. Get independent advice.