Getting the low-down on nursing homes (in California especially)

This post may be of interest to those who may have to place their family members in a nursing home, or those who may have to move to a nursing home themselves.

In last Monday’s New York Times, there was a very long but important article about how nursing homes game the Medicare rating system, “Nursing Home Compare”

You can find the article here:

The key criticism discussed is that Medicare ratings are:

“based in large part on self-reported data by the nursing homes that the government does not verify.  Only one of the three criteria [health inspections] used to determine the star ratings…relies on assessments from independent reviewers.  The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.”

A second criticism is that the ratings:

“do not take into account entire sets of potentially negative information, including fines and other enforcement actions by state, rather than federal, authorities.”

The authors argue that Medicare’s five-star ranking misleads consumers, who place their family members in these facilities.

The example given is Rosewood Post-Acute Rehab, a nursing home in Carmichael, near Sacramento.  For the last five years, this nursing home has a five-star ranking, the highest possible with Medicare.  Last year, the state of California fined Rosewood $100K — the highest possible fine — “for causing the 2006 death of a woman who was given an overdose of a powerful blood thinner.”

“From 2009 to 2013, California fielded 102 consumer complaints…at Rosewood, according to a state website.  California Advocates for Nursing Home Reform, which also tracks complaints, put the number even higher, at 164, which it says is twice the state average.”

But none of the state data ( or CANHR data ( is included on Medicare’s “Nursing Home Compare.”

Also, Rosewood got an average three-star rating on the health inspections.  They are able to get a five-star overall rating by self-reporting five stars on staffing and quality measures.  We are told that lots of nursing homes hire staff just before they have to report on staffing, and then lay the staff off once the staffing level has been reported.

Medi-Cal, California’s version of Medicaid, also gathers staffing levels of nursing homes in the state.  The authors discovered that “statewide, California nursing homes reported [staffing] levels to Medicare that were 15 percent higher than what they reported to Medi-Cal.”

The state data reflects staffing the whole year while the Medicare data reflects staffing only around the time of the annual report.

In the last several years, Rosewood has been the subject of a dozen lawsuits.  An eight-minute video on the NY Times website features the sad story of Essy Chandler and Rosewood.  The Chandler family is suing Rosewood because Mrs. Chandler died after falling several times at the nursing home.

The video is a good way to get the gist of the article.  Note that the article breezes over the Chandler lawsuit at the very end while the video features the Chandler family.

A link to the video is here:

The bottom line is that families should NOT rely on Medicare’s rating system for information about the quality of care provided at a nursing home.  Other information about nursing homes (in California) is available from:

  1. California Department of Public Health
  2. California Advocates for Nursing Home Reform (CANHR)
  3. long-term care ombuds
    list by county in California –
  4. families of current residents
  5. support groups
    At any given time, there is typically one support group member who has a loved one in a nursing home, whether it be for rehab or long-term care.

Let me know if you have other thoughts for how families can obtain reliable information about the quality of care at a particular nursing home.