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Choosing Nursing Homes More Tricky in Trump Era

January 11, 2018

By Mark Miller CHICAGO (Reuters) - Finding a safe, high-quality nursing home for a loved one is never an easy task. Complicated decisions often are made at a moment of emotional crisis and reliable guidance can be difficult to come by. And it is going to get more difficult.

The Trump administration is moving quickly to deregulate nursing homes, complying with a wish list submitted by industry lobbying groups. Consumer advocates worry that the changes will lead to deterioration in safety and the quality of care delivered to some of the most vulnerable Americans. Just before the holidays, news broke that the Trump administration is curtailing the use of penalties against nursing homes that harm their residents or put them at risk of injury.

The story, first reported in the New York Times (, is just the latest in a series of rapid-fire moves by the Centers for Medicare & Medicaid Services (CMS) to loosen, delay or strip away regulation of nursing homes. In November, CMS exempted nursing homes that violate new patient safety rules from financial penalties for 18 months. In June, it proposed to reverse an Obama administration rule prohibiting clauses in residents’ contracts requiring them to use arbitration to settle disputes rather than go to court. “The industry sees this administration as a real golden opportunity to get what it wants,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy (CMA), a nonprofit group that provides Medicare-related education, advocacy and legal assistance to seniors.

CMS has broad authority to regulate nursing homes that accept patients covered by Medicare and Medicaid - virtually all nursing homes in the United States. Its recent moves will take an industry where enforcement of rules has been weak, and make it weaker still, Edelman argues. Nursing homes subject to the Obama penalty rules generally were limited to those suspected of harming residents or placing them in immediate jeopardy. The repeal of CMS guidance in this area will leave even these nursing facilities facing looser regulation.

Nursing home choices often are made during stressful times for families, when a patient’s hospital stay is ending and the shift to a skilled nursing facility is imminent. That leaves the door open to rapid, emotion-driven decision making. “So don’t do that,” urged Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care. “It’s really a good idea to do a little research before a crisis emerges,” she said. “If something happened to me or a family member, where do I want to go?”

Unfortunately, information rating the quality of nursing homes is spotty. A good starting point is Medicare’s system for rating nursing homes for quality of care and staffing levels, called Nursing Home Compare ( The system rates nursing homes on a scale of 1 to 5 and is considered the industry authority. But much of the data that determines ratings is self-reported by nursing homes, and the ratings do not take into account negative information such as fines and enforcement actions by states. And reviews of this system have found numerous cases of facilities attempting to “game” the system.

One study published last year of California nursing homes between 2009 and 2013 found inflated star ratings. Forty percent of the facilities received four or five stars in 2009, but that had risen to 60% in 2013. The researchers found little correlation between the ratings and actual health inspections by state regulators. Nursing home shoppers also should consult Nursing Home Inspect, an online database created and maintained by ProPublica, the nonprofit investigative news service ( The database contains state-by-state breakdowns displaying fines and deficiencies turned up by inspections, and it flags nursing homes with histories of serious quality issues.

Grant recommends checking on any facility you are considering with your state’s long-term care ombudsman, a program administered by the Administration on Aging. Consumer Voice offers a directory of state ombudsmen on its website ( A trusted physician also can be a good resource, she said. “Ask them about experience with facilities. Ask a trusted doctor, 'What facilities would you go into if you needed one?'” She also recommends checking with friends who have had experience with facilities under consideration.

Geriatric care managers - human service professionals who help coordinate care for the elderly and their families - also can help navigate the nursing home maze. But consumer vigilance is an incomplete response to the rollback of regulatory protections now under way. “We’re talking about one of the most vulnerable populations in the country - many don’t have family living nearby or don’t have family members at all who can look out for them,” Grant said. And CMS data shows that 61 percent of nursing home residents in 2014 suffered from moderate or severe cognitive impairment, which means many will struggle to look out for their own interests. “If you are concerned about the quality of care in nursing homes now, you have no idea what will happen if we take away these protections.”

(The opinions expressed here are those of the author, a columnist for Reuters.)

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